Primary non-Hodgkin's lymphoma of the CNS treated with CHOD/BVAM or BVAM chemotherapy before radiotherapy: long-term survival and prognostic factors

• Published in: International journal of radiation oncology, biology, physics Vol. 59; no. 2; pp. 501 - 508
• Main Authors: Bessell, Eric M, Graus, Francesc, Lopez-Guillermo, Armando, Lewis, Sarah A, Villa, Salvador, Verger, Eugenia, Petit, Josep
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2004; Elsevier
• Subjects: Adult; Aged; Analysis of Variance; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carmustine - administration & dosage; Central Nervous System Neoplasms - drug therapy; Central Nervous System Neoplasms - mortality; Central Nervous System Neoplasms - radiotherapy; Chemotherapy; CNS lymphoma; Combined Modality Therapy; Cranial Irradiation; Cyclophosphamide - administration & dosage; Cytarabine - administration & dosage; Dexamethasone - administration & dosage; Doxorubicin - administration & dosage; Female; Humans; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - radiotherapy; Male; Medical sciences; Methotrexate - administration & dosage; Middle Aged; Prognostic factors; Radiotherapy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Survival; Survival Analysis; Technology. Biomaterials. Equipments. Material. Instrumentation; Vincristine - administration & dosage; Chemotherapy; Radiotherapy; CNS lymphoma; Survival; Prognostic factors; Biomedical engineering
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2003.11.001

To assess the long-term survival and prognostic factors associated with the cyclophosphamide, doxorubicin, vincristine, and dexamethasone (CHOD)/carmustine, vincristine, methotrexate, and cytarabine (BVAM) and BVAM chemotherapy regimens followed by cranial radiotherapy in the treatment of primary central nervous system (CNS) non-Hodgkin lymphoma. Since 1986, high-dose methotrexate (1.5 g/m 2), cytarabine, vincristine, and carmustine have been used in the BVAM chemotherapy regimen for primary CNS non-Hodgkin's lymphoma, with one cycle of CHOD given before BVAM in patients ≤70 years of age from 1990 onward. The median age for the 77 patients treated was 60 years and the median follow-up of surviving patients was 3 years (range, 1.4–15.2 years). The complete response rate after chemotherapy was 62% and after additional radiotherapy was 73%. Multivariate analysis of overall survival showed age ( p = 0.004), performance status ( p = 0.007), and number of tumors (unifocal disease vs. multifocal disease; p = 0.005) to be statistically significant prognostic factors. Survival decreased with increasing age and performance status score. Using a prediction score giving 1 point for each adverse prognostic factor (age ≥60 years, performance status ≥2, and multifocal and/or meningeal disease [advanced stage]), a score of 0 (8 patients) was associated with a median survival of 55 months, a score of 1 (29 patients) of 41 months, a score of 2 (28 patients) of 32 months, and a score of 3 (12 patients) a median survival of 1 month ( p <0.001). The actuarial overall survival for the 35 patients aged <60 years was 32.4% (95% confidence interval, 14.1–50.8%) at 10 years. The Nottingham/Barcelona prediction score, which is similar to the International Prognostic Index, may be useful in comparing survival with different regimens studied in Phase II trials. Patients with primary CNS non-Hodgkin's lymphoma aged <60 years treated with CHOD/BVAM or BVAM followed by radiotherapy have a similar long-term survival to that of patients with large B cell non-Hodgkin's lymphoma at other extranodal sites.