In primary CNS lymphoma (PCNSL) irradiation alone is no longer the primary treatment and combination with chemotherapy has significantly improved response and survival. However, patients treated with combined modality therapy suffer from significant neurotoxicity. Therefore, studies with chemotherapy alone have been carried out. We recently reported on a phase II multicenter trial to evaluate event-free survival, overall survival, response rate, response duration and toxicity of combination chemotherapy in patients with previously untreated PCNSL. 65 consecutive patients with histologically proven PCNSL received a total of 6 courses of combination chemotherapy with 3 different courses of chemotherapy. In patients with response these 3 cylces were repeated. The combination chemotherapy included high-dose methotrexate (MTX) (5g/m2, course 1,2,4,5) and cytarabine (ara-C) (3g/m2/d, d1-2, courses 3,6) combined with dexamethasone (courses 3–6), vinca alkaloids and ifosfamide alternating with cyclophosphamide. In addition, MTX, prednisolone and ara-C were applied via an Ommaya or Rickham reservoir in each course. The study population included 65 consecutive patients with a median age of 62 years with a range between 27 and 75. 62 patients are evaluable for response. There were 9% therapy-related deaths mainly due to neutropenic infections. Ommaya reservoir infections occurred in 12/64 (19%) and acute transient MTX related encephalopathy in 2 (subacute in 1) patients. The 5-year-survival of patients below 61 years was 75%, of patients of 61 years or older 17% (

Pels H et al.,
J Clin Oncol
21
(24),
2003
). The results for patients younger than 60 years could be superior to previously reported therapy regimes. The survival rates for patients above 60 years are comparable to those reported for combined radiochemotherapy. However, in contrast to radiochemotherapy permanent treatment-associated neurotoxicity is infrequent. Based on these data we constructed a follow-up trial. Patients below the age of 61 are treated as in the antecedent protocol without intraventricular therapy. Patients above 60 are treated in a protocol modified by the addition of procarbazine in 2 cycles and a maintenance therapy with procarbazine. First results of this follow-up trial will be presented.

Topics:
combination drug therapy, primary central nervous system lymphoma, chemotherapy regimen, cytarabine, follow-up, infections, neurotoxicity syndromes, procarbazine, radiochemotherapy, combined modality therapy

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2005, The American Society of Hematology
2004
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