title: Immunochemotherapy with rituximab, methotrexate, procarbazine, and lomustine for primary CNS lymphoma (PCNSL) in the elderly.
abstract: BACKGROUND
  Primary central nervous system lymphoma (PCNSL) is an aggressive extranodal non-Hodgkin lymphoma confined to the central nervous system. In this article, we report the results of a pilot trial adding rituximab to the established regimen consisting of methotrexate, procarbazine, and lomustine (R-MCP).
  
  
  METHODS
  PCNSL patients ≥65 years without Karnofsky performance score (KPS) limit were included. R-MCP regimen consisted of rituximab (375 mg/m(2) i.v. on days -6, 1, 15, and 29), methotrexate (3 g/m(2) i.v., days 2, 16, and 30) followed by folinic rescue, procarbazine (60 mg/m(2) orally, days 2-11), and lomustine (110 mg/m(2) orally, day 2). A maximum of three 43-day cycles were applied. Primary end point was response to treatment obtained by magnetic resonance imaging. Secondary end points were overall survival (OS) and progression-free survival (PFS).
  
  
  RESULTS
  Twenty-eight patients were included (median age 75, median KPS 60%). Best documented response: complete remission in 18 of 28 (64%), partial remission in 5 of 28 (18%), stable disease in 1 of 28 (4%), and progressive disease in 2 of 28 (7%) patients. Response was not assessed in two patients. Two treatment-associated deaths were observed. After a median follow-up of 36 months, the 3-year PFS and OS was 31%.
  
  
  CONCLUSIONS
  R-MCP regimen is well tolerated and active in elderly patients with newly diagnosed PCNSL.
authors.affiliation: Department of Hematology and Oncology.
authors.forename: K
authors.initials: K
authors.lastname: Fritsch
authors.affiliation: Department of Hematology and Oncology.
authors.forename: B
authors.initials: B
authors.lastname: Kasenda
authors.affiliation: Department of Neuroradiology.
authors.forename: C
authors.initials: C
authors.lastname: Hader
authors.affiliation: Department of Stereotactic and Functional Neurosurgery.
authors.forename: G
authors.initials: G
authors.lastname: Nikkhah
authors.affiliation: Department of Neuropathology, Freiburg University Medical Center, Freiburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Prinz
authors.affiliation: Department of Hematology and Oncology.
authors.forename: V
authors.initials: V
authors.lastname: Haug
authors.affiliation: Department of Hematology and Oncology.
authors.forename: S
authors.initials: S
authors.lastname: Haug
authors.affiliation: Department of Hematology and Oncology.
authors.forename: G
authors.initials: G
authors.lastname: Ihorst
authors.affiliation: Department of Hematology and Oncology.
authors.forename: J
authors.initials: J
authors.lastname: Finke
authors.affiliation: Department of Hematology and Oncology. Electronic address: gerald.illerhaus@uniklinik-freiburg.de.
authors.forename: G
authors.initials: G
authors.lastname: Illerhaus
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage / Q000009:adverse effects; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D010865:Pilot Projects; D011344:Procarbazine / Q000008:administration & dosage / Q000009:adverse effects; D000069283:Rituximab; D016019:Survival Analysis
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D011344:Procarbazine; D000069283:Rituximab; D008130:Lomustine; D008727:Methotrexate