Treatment patterns and disease course of previously untreated Primary Central Nervous System Lymphoma: Feasibility of MTX‐based regimens in clinical routine

• Published in: European journal of haematology Vol. 107; no. 2; pp. 202 - 210
• Main Authors: Sieg, Noëlle, Naendrup, Jan‐Hendrik, Gödel, Philipp, Balke‐Want, Hyatt, Simon, Florian, Deckert, Martina, Gillessen, Sarah, Kreissl, Stefanie, Bröckelmann, Paul J., Borchmann, Peter, Tresckow, Bastian, Heger, Jan‐Michel
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.08.2021
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; ASCT; B‐NHL; Central nervous system; Central Nervous System Neoplasms - diagnosis; Central Nervous System Neoplasms - drug therapy; Central Nervous System Neoplasms - mortality; Clinical trials; Combined Modality Therapy; Female; Germany; Humans; IELSG; Lymphoma; Lymphoma - diagnosis; Lymphoma - drug therapy; Lymphoma - mortality; Male; MARTA; MATRix; Methotrexate; Methotrexate - administration & dosage; Middle Aged; Nervous system; Patients; PCNSL; Practice Patterns, Physicians; PRIMAIN; Prognosis; Recurrence; Retreatment; Rituximab; Survival; Survival Analysis; Treatment Outcome; Young Adult; Germany; B-NHL; MARTA; IELSG; MATRix; PCNSL; PRIMAIN; ASCT
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.13639

Background Primary central nervous system lymphoma (PCNSL) is a rare type of aggressive lymphoma of the central nervous system. Treatment strategies improved significantly over the past decades differ regionally but mainly consist of rituximab and high‐dosed methotrexate (MTX)‐based therapies. Methods We assessed clinical outcomes of 100 patients with newly diagnosed PCNSL between 2010‐2020 at the University Hospital of Cologne, Germany. Results Patients were 23‐88 years of age and either treated with MTX‐based regimens (PRIMAIN, MARTA, MATRix), individual regimens, or best supportive care, respectively. Overall response rates were generally high (66,7‐83,8%), but different organ toxicities required dose adjustments in most groups. Two‐year overall survival rates were 57,9% (PRIMAIN), 63,6% (MARTA), 65,4% (MATRix), and 37,5% (Other), respectively. Out of 9 patients suffering from relapse >12 months from primary diagnosis, 7 patients (77,8%) received methotrexate‐based salvage therapy with 2‐year overall survival of 4/6 patients (66,7%). Conclusion Although a relevant proportion of patients are not eligible for clinical trials due to age, performance status, or comorbidities, these results prove feasibility of different MTX‐based treatment strategies in clinical routine. Even elderly patients displayed surprisingly favorable outcomes. However, with compromising organ toxicities, reduction of intensity should be part of strategies in future clinical trials.