title: High-Dose Methotrexate and Cytarabine-Based Multi-Agent Chemotherapy (Modified Bonn Protocol) for Systemic Lymphoma with CNS Involvement.
abstract: The prognosis of patients with systemic lymphoma with central nervous system (CNS) involvement is very poor and there is no established standard therapy. We retrospectively analyzed 18 patients (4 untreated and 14 relapsed) with systemic lymphoma with CNS involvement who received methotrexate and cytarabine-based multiagent chemotherapy (modified Bonn protocol). Complete and partial responses were achieved in 56 and 22% of the patients, respectively. The 1-year overall survival (OS) and progression-free survival (PFS) was 81.0 and 39.2%, respectively. Patients with parenchymal involvement showed a better 1-year PFS than those with either leptomeningeal involvement or both. In a multivariate analysis, poor performance status (PS) was the only independent prognostic factor for the 1-year OS and PFS (HR 10.8, 95% CI 1.09-108, p = 0.042; HR 20.8, 95% CI 2.39-181, p = 0.006, respectively). Grade 4 neutropenia and thrombocytopenia occurred in 17 patients each (94%), but there were no grade 4 nonhematopoietic adverse events. The modified Bonn protocol resulted in relatively favorable response and survival, and provided clinical benefits to patients with good PS, in particular. This study demonstrated that the modified Bonn protocol could be a feasible and encouraging treatment approach for lymphoma with CNS and systemic involvement.
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Kento
authors.initials: K
authors.lastname: Umino
authors.forename: Shin-Ichiro
authors.initials: SI
authors.lastname: Fujiwara
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sato
authors.forename: Daisuke
authors.initials: D
authors.lastname: Minakata
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nakano
authors.forename: Ryoko
authors.initials: R
authors.lastname: Yamasaki
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kawasaki
authors.forename: Miyuki
authors.initials: M
authors.lastname: Sugimoto
authors.forename: Chihiro
authors.initials: C
authors.lastname: Yamamoto
authors.forename: Kaoru
authors.initials: K
authors.lastname: Hatano
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Okazuka
authors.forename: Iekuni
authors.initials: I
authors.lastname: Oh
authors.forename: Ken
authors.initials: K
authors.lastname: Ohmine
authors.forename: Takahiro
authors.initials: T
authors.lastname: Suzuki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Muroi
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000401:mortality; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D003561:Cytarabine; D008727:Methotrexate