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High-dose methotrexate-based immuno-chemotherapy for elderly primary CNS lymphoma patients (PRIMAIN study)

2016; Springer Nature; Volume: 31; Issue: 4 Linguagem: Inglês

10.1038/leu.2016.334

1476-5551

Kristina Fritsch, Benjamin Kasenda, Elisabeth Schorb, Peter Hau, Johannes Bloehdorn, Robert Möhle, Steffen Löw, Mascha Binder, J. Atta, Ulrich Keller, H-H Wolf, Stefan W. Krause, Georg Heß, Ralph Naumann, Stephanie Sasse, Carsten Hirt, Monika Lamprecht, Uwe M. Martens, Anke Morgner, Jens Panse, Norbert Frickhofen, Alexander Röth, Claudia Hader, Martina Deckert, Heidi Fricker, Gabriele Ihorst, Jürgen Finke, Gerald Illerhaus,

Glioma Diagnosis and Treatment

To investigate immuno-chemotherapy for elderly immuno-competent patients (⩾65 years) with newly diagnosed primary central nervous system lymphoma, we conducted a multicentre single-arm trial. One cycle consisted of rituximab (375 mg/m2, days 1, 15, 29), high-dose methotrexate (3 g/m2 days 2, 16, 30), procarbazine (60 mg/m2 days 2–11) and lomustine (110 mg/m2, day 2)—R-MPL protocol. Owing to infectious complications, we omitted lomustine during the study and consecutive patients were treated with the R-MP protocol. Three cycles were scheduled and repeated on day 43. Subsequently, patients commenced 4 weekly maintenance treatment with procarbazine (100 mg for 5 days). Primary end point was complete remission (CR) after 3 cycles. We included 107 patients (69 treated with R-MPL and 38 with R-MP). In all, 38/107 patients achieved CR (35.5%) and 15 (14.0%) achieved partial remission. R-MP was associated with a lower CR rate (31.6%) compared with R-MPL (37.7%), but respective 2-year progression-free survival (All 37.3%; R-MP 34.9%; R-MPL 38.8%) and overall survival (All 47.0%; R-MP 47.7%; R-MPL 46.0%) rates were similar. R-MP was associated with less ⩾grade 3 toxicities compared with R-MPL (71.1% vs 87.0%). R-MP is more feasible while still associated with similar efficacy compared with R-MPL and warrants further improvement in future studies.