title: Impact of treatment variability on survival in immuno-competent and immuno-compromised patients with primary central nervous lymphoma.
abstract: Patients with primary central nervous system lymphoma (PCNSL) treated in the 'real-world' setting do not represent those treated on clinical trials and might not be treated similarly. We studied characteristics and variability in care for 113 newly diagnosed PCNSL patients treated at 5 institutions in the Chicago area between 2000 and 2012. In 111 patients, single modality therapy with a high dose methotrexate (HD-MTX) regimen +/- rituximab, was most commonly employed (n = 65), and 34 underwent radiotherapy (+/- systemic therapy). Fifty-eight of 108 patients received rituximab. Twenty-nine of 110 patients (26%) received intrathecal chemotherapy (ITC). Overall response rate was 80% (47% complete responses). With a median follow-up of 18·7 months, median overall survival (OS) was 65·2 months. In univariate analysis, HD-MTX (median OS 72·7 vs. 2·7 months, P < 0·001) and rituximab (median not reached versus 28·4 months, P = 0·005) impacted OS favourably. This significance was sustained regardless of immune status and in multivariate analysis. Whole brain radiotherapy (WBRT) resulted in a trend for improved OS as compared with systemic therapy alone (P = 0·09), while ITC did not impact survival. Clinical practice has evolved to exclude WBRT and ITC while incorporating rituximab with clinical outcomes comparable in immuno-competent/compromised patients and similar to those achieved in recent clinical trials.
authors.affiliation: Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Reem
authors.initials: R
authors.lastname: Karmali
authors.affiliation: Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA.
authors.forename: Chadi
authors.initials: C
authors.lastname: Nabhan
authors.affiliation: Division of Hematology/Oncology, Northwestern University, Chicago, IL, USA.|AbbVie, Chicago, IL, USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Petrich
authors.affiliation: The Ken & Ruth Davee Department of Neurology, Northwestern University, Chicago, IL, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Raizer
authors.affiliation: Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Peace
authors.affiliation: Department of Neurology, University of Chicago, Chicago, IL, USA.
authors.forename: Rimas
authors.initials: R
authors.lastname: Lukas
authors.affiliation: Division of Hematology/Oncology, Northwestern University, Chicago, IL, USA.
authors.forename: Leo I
authors.initials: LI
authors.lastname: Gordon
authors.affiliation: Rush University Cancer Center, Rush University, Chicago, IL, USA.
authors.forename: Sanjib
authors.initials: S
authors.lastname: Basu
authors.affiliation: Rush University Cancer Center, Rush University, Chicago, IL, USA.
authors.forename: Vineela
authors.initials: V
authors.lastname: Chukkapalli
authors.affiliation: Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Venugopal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D016543:Central Nervous System Neoplasms / Q000276:immunology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007109:Immunity; D016867:Immunocompromised Host; D008223:Lymphoma / Q000276:immunology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: central nervous system; chemotherapy; clinical research; epidemiology; extranodal lymphoma; non-Hodgkin lymphoma