title: Factors influencing the response to high dose methotrexate-based vincristine and procarbazine combination chemotherapy for primary central nervous system lymphoma.
abstract: The authors investigated objective response rate to high dose methotrexate (HDMTX)-based combination chemotherapy in primary central nervous system lymphoma (PCNSL), and sought to identify factors that influence response to HDMTX-based combination therapy. Prospective observational analysis was performed on 52 PCNSL patients. All patients received HDMTX (3.5 g/m(2)) and vincristine (1.4 mg/m(2)/day) for one day during weeks 1, 3, 5, 7, and 9, and procarbazine (100 mg/m(2)/day) for one week during weeks 1, 5, and 9. Forty-one patients (78.8%) achieved complete or partial remission. Higher objective response rates were observed for patients with: 1) age < 60 yr; 2) Eastern Cooperative Oncology Group (ECOG) performance score of < 2; 3) low risk status as defined by the International Extranodal Lymphoma Study Group; 4) p53 positivity; 5) XBP-1 negativity; 6) MUM-1 negativity; and 7) homogenous gadolinium enhancement in MR images. Multivariate analysis showed that ECOG performance score of < 2, low risk, negativity for XBP-1, homogenous gadolinium enhancement by MRI, and response to chemotherapy were associated with longer overall survival. In particular, it is interesting to note that patients with a PCNSL that is homogeneously enhanced by gadolinium have a higher objective response rate, and a longer progression-free survival and overall survival.
authors.affiliation: Department of Neurosurgery and Division of Neurooncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158 Paryong-ro, Masanhoewon-gu, Changwon, Korea.
authors.forename: Kang Hyun
authors.initials: KH
authors.lastname: Sung
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Lee
authors.forename: Young Zoon
authors.initials: YZ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000401:mortality; D003287:Contrast Media / Q000737:chemistry; D004268:DNA-Binding Proteins / Q000378:metabolism; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium / Q000737:chemistry; D006801:Humans; D050835:Interferon Regulatory Factors / Q000378:metabolism; D008223:Lymphoma / Q000188:drug therapy* / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D016017:Odds Ratio; D011344:Procarbazine / Q000008:administration & dosage*; D011446:Prospective Studies; D012008:Recurrence; D000071701:Regulatory Factor X Transcription Factors; D012720:Severity of Illness Index; D014157:Transcription Factors / Q000378:metabolism; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism; D014750:Vincristine / Q000008:administration & dosage*; D000071717:X-Box Binding Protein 1; D000099218:Interferon Regulatory Factor-4
chemical_list: D003287:Contrast Media; D004268:DNA-Binding Proteins; D005682:Gadolinium; D050835:Interferon Regulatory Factors; D008727:Methotrexate; D011344:Procarbazine; D000071701:Regulatory Factor X Transcription Factors; D014157:Transcription Factors; D016159:Tumor Suppressor Protein p53; D014750:Vincristine; D000071717:X-Box Binding Protein 1; D000099218:Interferon Regulatory Factor-4; C495901:TP53 protein, human; C000605543:XBP1 protein, human