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Tang Z, Wu G, Tan F, Long Y, Hong J, Lyu Z, Wei R. Survival outcomes and treatment experience of 124 patients with primary central nervous system lymphoma. Strahlenther Onkol 2024; 200:760-773. [PMID: 38466403 DOI: 10.1007/s00066-024-02219-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/11/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is a rare malignancy of the central nervous system with high invasiveness. There is little consensus on the treatment of PCNSL. This study retrospectively studied data from PCNSL patients in a single center to summarize treatment experience and explore prognostic factors. METHODS Survival curves were drawn using the Kaplan-Meier method and prognostic factors were analyzed using Cox's hazards model. RESULTS In multivariate analysis, cerebrospinal fluid lactic acid dehydrogenase (CSF LDH; p = 0.005 and p = 0.002), neutrophil to lymphocyte ratio (NLR; p = 0.014 and p = 0.038), and completion of four cycles of induction therapy (p < 0.001and p < 0.001) were significant and independent predictors of overall survival (OS) and progression-free survival (PFS), respectively. CONCLUSION On the basis of this study, we propose that PCNSL patients should receive early induction therapy with sufficient cycles. Subsequent consolidation therapy can prevent relapses and improve survival. In patients with PCNSL, the independent prognostic factors for OS and PFS were CSF LDH level, NLR, and full cycles of induction therapy.
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Affiliation(s)
- Ziqing Tang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Geting Wu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Fang Tan
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Long
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jidong Hong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiping Lyu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Rui Wei
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Das S, Bagal B, Jain H, Kashyap L, Anbarasan S, Abhishek S, Bondili S, Nayak L, Thorat J, Mirgh S, Gokarn A, Punatar S, Ayushi S, Epari S, Tembhare P, Shetty P, Khanna N, Goda J, Aliasgar M, Gupta T, Sengar M, Khattry N, Laskar S, Menon H. Demographics, Pattern of Care & Outcomes of Primary CNS Lymphoma- Experience from a Tertiary Care Cancer Center in India. Indian J Hematol Blood Transfus 2023; 39:57-70. [PMID: 36699441 PMCID: PMC9868032 DOI: 10.1007/s12288-022-01557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/04/2022] [Indexed: 01/28/2023] Open
Abstract
Primary CNS lymphoma (PCNSL) is a rare subtype of non-Hodgkin lymphoma with the worst outcomes amongst all extranodal lymphomas. There is a scarcity of data on real-world outcomes of primary CNS lymphoma (PCNSL) owing to the rarity of the disease. This study analyzed the demographic patterns, risk stratification, treatment regimens used, & outcomes of patients treated at Tata Memorial Center Mumbai, India. This is a retrospective analysis of newly diagnosed primary CNS lymphoma patients treated at our centre over seven years from January 2013 to December 2019. A total of 142 patients with PCNSL were diagnosed during this period. Thirty (21.1%) patients were deemed ineligible for any systemic or local therapies,ten patients were referred to other hospitals, two patients had relapsed disease, and one was excluded because age less than 18 years. Finally 99 patients were included in the final analysis. Among these 99 patients,72 patients (72.7%) were < 60 years,70 (70.7%) patients had Eastern cooperative oncology group (ECOG) performance status (PS) less than equal to 2. DLBCL was the most common histology (86.4%) while rests were high grade B cell NHL NOS (11.4%),Burkitt's Lymphoma(1%),Peripheral T-cell Lymphoma NOS (1.2%). Only one of 99 patients was positive for HIV serology. Multiple intracranial lesions were found in 59.5%. Surgical resection was performed in 28.4% of patients. Out of 63 patients in whom the International extranodal lymphoma study group (IELSG) score is available, 34(54%) were IELSG high-risk groups. As per Memorial Sloan Kettering Cancer Center (MSKCC) risk grouping, patients were almost equally distributed in all the risk groups, with 32(32.3%) patients in risk group 1 (age < 50 years), 36(36.4%) patients in risk group 2 (age > 50 years, KPS > = 70), and 31(31.3%) patients in risk group 3 age > 50 years, KPS < 70). First-line treatment with high dose methotrexate (HD-MTX) based regimens was administered to 92 (92.9%) patients, and 72.8% of these patients received rituximab. Of these 92 patients, 59 (64.1%) patients could complete induction, and 52 patients received consolidation. Thirty-one patients received high dose cytarabine based chemo consolidation, one patient underwent high dose chemotherapy followed by autologous stem cell transplantation (ACST), and 19 patients received whole-brain radiotherapy (WBRT) and 1 patient received temozolomide as consolidation regimen. Thus only 52 patients completed the entire course of induction with consolidation therapy. The response to treatment was assessed using International PCNSL Collaborative Group Criteria. Post completion of consolidation, 49(94.2%) patients had a complete response. With a median follow-up duration of 39.2 months, the median progression-free survival (PFS) and the median overall survival (OS) of the patients taken into the analysis (N = 99) were 21 and 37 months respectively. On multivariate analysis, age < 60 yrs, > = 5 HD-MTX cycles received & the use of rituximab predicted better OS.Outcomes of patients with PCNSL treated with HD-MTX based therapy are comparable to reported literature however a large proportion of patients do not undergo required treatment despite the curable nature of disease. Supplementary Information The online version supplementary material available at 10.1007/s12288-022-01557-7.
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Affiliation(s)
- Shasanka Das
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Lakhan Kashyap
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Sekar Anbarasan
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Sharma Abhishek
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Suresh Bondili
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Lingraj Nayak
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Jayshree Thorat
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Sumeet Mirgh
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Anant Gokarn
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Sachin Punatar
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Sahay Ayushi
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Sridhar Epari
- Homi Bhabha National Institute, Mumbai, India
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Prashant Tembhare
- Homi Bhabha National Institute, Mumbai, India
- Department of Hemato-pathology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Prakash Shetty
- Homi Bhabha National Institute, Mumbai, India
- Department of Neurosurgery, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Nehal Khanna
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Jayant Goda
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Moiyadi Aliasgar
- Homi Bhabha National Institute, Mumbai, India
- Department of Neurosurgery, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Tejpal Gupta
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Navin Khattry
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Homi Bhabha National Institute, Mumbai, India
| | - Siddhartha Laskar
- Homi Bhabha National Institute, Mumbai, India
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
| | - Hari Menon
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra India
- Department of Hematology and Medical Oncology, St John's Medical College Hospital, Bengaluru, India
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Singh C, Jain A, Takkar A, Agarwal A, Rohilla M, Lad D, Khadwal A, Basher R, Radotra BD, Bal A, Das A, Gupta V, Lal V, Varma S, Malhotra P, Prakash G. Successful Use of High Dose Methotrexate in Treatment of Primary CNS Lymphoma Patients Without Access to Serum Methotrexate Levels Monitoring: Challenges and Outcome. Indian J Hematol Blood Transfus 2022; 38:68-77. [PMID: 35125713 PMCID: PMC8804055 DOI: 10.1007/s12288-021-01438-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/19/2021] [Indexed: 01/03/2023] Open
Abstract
AIMS AND OBJECTIVES High dose methotrexate (HDMTx) based chemotherapy forms the backbone of therapy for patients with Primary Central Nervous system Lymphoma (PCNSL). However, delivering HDMTx in resource constrained settings, especially without therapeutic drug monitoring, is difficult. We share our experience of treatment of patients with PCNSL at our center over a 10-year period with local adaptations made to deliver HDMTx. MATERIALS AND METHODS We retrospectively analysed the case records of patients diagnosed with a PCNSL over the course of 10 years from 2010 to 2020. RESULTS Fifty-five patients received therapy for newly diagnosed PCNSL. Thirty-six patients received Modified De-Angelis protocol ± Rituximab with curative intent. Fourteen of these patients were unable to complete the protocol with the most common cause being development of methotrexate toxicity. Patients unable to complete the designated 5 cycles of HDMTx had a poorer PS and higher probability of having a high IELSG score at baseline. Nineteen patients were given non HDMTx based therapy either due to advanced age or poor performance status. Twenty-nine patients (52.7%) were able to achieve a complete response. The most common cause of mortality was relapse/progressive disease. The Median EFS and OS of the cohort was 29 months and 40 months respectively. CONCLUSION All attempts should be made to have therapeutic drug level monitoring for administration of HDMTX based therapy for the patients with PCNSL, more so in patients who have poor performance status and a high IELSG score. If it is imperative to give HDMTx without access to TDM facility then a possible risk of higher toxicity should be explained to all patients, beforehand.
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Affiliation(s)
- Charanpreet Singh
- Clinical Hematology and BMT Division, Department of Internal Medicine, Nehru Hospital, Postgraduate Institute of Medical Education and Research, F block, 4th Floor, Chandigarh, 160012 India
| | - Arihant Jain
- Clinical Hematology and BMT Division, Department of Internal Medicine, Nehru Hospital, Postgraduate Institute of Medical Education and Research, F block, 4th Floor, Chandigarh, 160012 India
| | - Aastha Takkar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rohilla
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- Clinical Hematology and BMT Division, Department of Internal Medicine, Nehru Hospital, Postgraduate Institute of Medical Education and Research, F block, 4th Floor, Chandigarh, 160012 India
| | - Alka Khadwal
- Clinical Hematology and BMT Division, Department of Internal Medicine, Nehru Hospital, Postgraduate Institute of Medical Education and Research, F block, 4th Floor, Chandigarh, 160012 India
| | - Rajender Basher
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - B. D. Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Clinical Hematology and BMT Division, Department of Internal Medicine, Nehru Hospital, Postgraduate Institute of Medical Education and Research, F block, 4th Floor, Chandigarh, 160012 India
| | - Pankaj Malhotra
- Clinical Hematology and BMT Division, Department of Internal Medicine, Nehru Hospital, Postgraduate Institute of Medical Education and Research, F block, 4th Floor, Chandigarh, 160012 India
| | - Gaurav Prakash
- Clinical Hematology and BMT Division, Department of Internal Medicine, Nehru Hospital, Postgraduate Institute of Medical Education and Research, F block, 4th Floor, Chandigarh, 160012 India
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VS R, D P, H M, P M, R A, S S, D D, I A, Z L, N A, A N, J K, R J, SJ B, M P, DK M, M C, R N. Primary Central Nervous System Lymphoma: Long-Term Treatment Outcomes and Cost-Analysis from a Retrospective Study of High-Dose Methotrexate Based Chemoimmunotherapy and Reduced Dose Radiation Therapy Approach. Indian J Hematol Blood Transfus 2021; 38:223-234. [PMID: 35496970 PMCID: PMC9001787 DOI: 10.1007/s12288-021-01444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022] Open
Abstract
Standard treatment of primary central nervous system lymphoma (PCNSL) in countries with limited resources remains conventional chemotherapy, with or without whole brain radiotherapy (WBRT). To evaluate the treatment outcomes, prognostic factors and costs in patients with PCNSL treated with high-dose Methotrexate, vincristine and procarbazine, plus Rituximab (MVP-R) followed by consolidation with reduced dose (rd) WBRT and Cytarabine chemotherapy. We conducted an institutional audit of the first line treatment of patients with PCNSL, who were treated with MVP-R regimen, WBRT, or both between September 2011 and January 2020. Long term neuro-cognitive toxicity was recorded on follow up. The 5-year overall survival (OS) was the primary end point. Of 54 patients, 42 were evaluable [median age: 54 years (19-73 years)]. The commonest subtype was activated B-cell subtype (90%). At presentation, multiple and deep brain lesions were reported in 38 and 73% patients, respectively. Combined chemoimmunotherapy was given to 41 patients and WBRT to 29 patients. 27 patients (65%) achieved a complete response, and 22 received rdWBRT. 7 patients with partial response received conventional dose WBRT. Among tested prognostic factors, response to treatment was the single most significant determinant. At a median follow-up of 58 months, the 5-year progression free survival was 42%, and 5-year OS was 60%. The median direct hospital costs incurred by most patients for investigations and treatment were $1976.45 and $12,078.49, respectively. MVP-R is a well-tolerated regimen with substantial long term outcomes. Among all prognostic factors, response to therapy is the most significant.
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Affiliation(s)
- Radhakrishnan VS
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Podder D
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Mukherjee H
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Mandal P
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Achari R
- Department of Radiation Oncology, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Sen S
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Dey D
- Department of Histopathology and Hemato-Pathology, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Arun I
- Department of Histopathology and Hemato-Pathology, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Latif Z
- Department of Histopathology and Hemato-Pathology, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Arora N
- Department of Histopathology and Hemato-Pathology, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Nag A
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Kumar J
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Javed R
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Bhave SJ
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Parihar M
- Department of Histopathology and Hemato-Pathology, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Mishra DK
- Department of Histopathology and Hemato-Pathology, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Chandy M
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - Nair R
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
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