title: Prophylactic intrathecal chemotherapy in primary CNS lymphoma.
abstract: The role of prophylactic intrathecal chemotherapy in the treatment of primary central nervous system lymphoma remains controversial. We report a retrospective single center study of a cohort of 69 patients with primary central nervous system lymphoma who had been treated with a regimen that combined high intravenous doses of Methotrexate, CCNU, procarbazine and methylprednisolone. Before 2000, patients systematically received intrathecal prophylaxis including Methotrexate, cytarabine, and hydrocortisone delivered either by intraventricular or lumbar injection along with the systemic chemotherapy (group A, n = 39). After this date, the procedure was changed and intrathecal chemotherapy was withdrawn from the protocol (group B, n = 30). The median age and Karnofsky index were comparable in both groups. At the time of analysis, we found no significant difference between patients with and without intrathecal prophylaxis in terms of objective response rate, patterns of relapse, progression-free survival or overall survival. In our study, intrathecal prophylaxis withdrawal from a high dose intravenous Methotrexate-based chemotherapy regimen did not influence disease control and outcome of primary central nervous system lymphoma. Further studies prospectively investigating the role of intrathecal chemoprophylaxis are warranted for this disease.
authors: Service de Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651 Paris, France. sierradelrio75@hotmail.com
authors: Monica
authors: M
authors: Sierra Del Rio
authors: Damien
authors: D
authors: Ricard
authors: Caroline
authors: C
authors: Houillier
authors: Soledad
authors: S
authors: Navarro
authors: Alberto
authors: A
authors: Gonzalez-Aguilar
authors: Ahmed
authors: A
authors: Idbaih
authors: Gentian
authors: G
authors: Kaloshi
authors: Soufiane
authors: S
authors: Elhallani
authors: Antonio
authors: A
authors: Omuro
authors: Sylvain
authors: S
authors: Choquet
authors: Carole
authors: C
authors: Soussain
authors: Khé
authors: K
authors: Hoang-Xuan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D017567:Karnofsky Performance Status; D008130:Lomustine / Q000008:administration & dosage; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D018696:Neuroprotective Agents / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D018696:Neuroprotective Agents; D011344:Procarbazine; D008130:Lomustine; D008775:Methylprednisolone; D008727:Methotrexate