Abstract
Aim:To describe the long-term outcomes of patients with lymphoma in the CNS treated with rituximab, temozolomide and high-dose methotrexate without consolidation therapy.Patients & methods:A retrospective cohort study of 46 consecutive patients with primary CNS lymphoma (PCNSL, 27 patients) or secondary CNS involvement of diffuse large B-cell lymphoma (DLBCL, 19 patients) who were treated with rituximab on day 1 in combination with high-dose methotrexate (days 1 and 15) and temozolomide (days 1–5) in 28-day cycles without further consolidation.Results:Median follow-up was 21.2 months. Patients received a median of five cycles (range 1–15). Median overall survival (OS) was 26 months and median progression-free survival was 8.6 months. At 3 years, 37% of patients were alive and without evidence of disease. The patients with PCNSL had a significantly higher response rates (ORR 81 vs 47%; p = 0.015) and longer median OS (55.3 vs 4.8 months; p < 0.01) than those with secondary CNS DLBCL. Toxicities were mild and manageable.Conclusion:The rituximab, temozolomide and methotrexate regimen is an effective therapy for patients with PCNSL without the toxicities typically associated with consolidation therapy.
Highlights
At 3 years, 33% of patients were alive and without evidence of disease. The patients with primary CNS lymphoma (PCNSL) had a significantly longer median overall survival (OS) than those with secondary CNS diffuse large B-cell lymphoma (DLBCL). Patients who were in a complete or partial response after two cycles of rituximab, temozolomide and methotrexate had an improved OS compared with those who had stable or progressive disease. Acute toxicities included acute kidney injury, transaminitis, sepsis, mucositis and lung injury, but there were no long-term adverse effects of this regimen. The rituximab, temozolomide and methotrexate regimen without consolidation is an effective therapy for patients with PCNSL without the toxicities typically associated with consolidation therapy
In conclusion, we show that a prolonged course of RTM without consolidation is a favorable first-line treatment strategy for patients with PCNSL
It is associated with low rate of treatment discontinuation due to toxicity and its efficacy is within the range of previously described approaches that are frequently too toxic in older patients or those with comorbidities
Summary
• At 3 years, 33% of patients were alive and without evidence of disease. • The patients with PCNSL had a significantly longer median OS than those with secondary CNS DLBCL. • Patients who were in a complete or partial response after two cycles of rituximab, temozolomide and methotrexate had an improved OS compared with those who had stable or progressive disease. • Acute toxicities included acute kidney injury, transaminitis, sepsis, mucositis and lung injury, but there were no long-term adverse effects of this regimen. • The rituximab, temozolomide and methotrexate regimen without consolidation is an effective therapy for patients with PCNSL without the toxicities typically associated with consolidation therapy.
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