Primary central nervous system lymphoma: The Cleveland Clinic experience.

Abstract

2092 Background: Primary central nervous system lymphoma (PCNSL) is an uncommon variant of extranodal non-Hodgkin lymphoma that involves the brain, leptomeninges, eyes, or spinal cord without evidence of systemic disease. Untreated PCNSL has a rapidly fatal course, with survival of approximately 1.5 months from the time of diagnosis. In this study, we sought to describe the demographics, diagnoses, management, and outcomes of patients with PCNSL at a single institution. Methods: After obtaining IRB approval, the Cleveland Clinic Brain Tumor and Neuro-Oncology Center’s database was used to identify patients with histologically proven PCNSL at the Cleveland Clinic between 1986 and 2010. Data were subjected univariate and multivariate analysis followed by recursive partitioning analysis in order to generate a prognostic model. Results: 153 patients were diagnosed with PCNSL with a median age of 61 and Karnofsky performance status (KPS) of 70. The progression-free survival (PFS) was 9.3 months; the overall survival (OS) was 27 months. The treatment regimen included methotrexate-based chemotherapy (MTX) or a combination of methotrexate-based chemotherapy and whole brain radiation therapy (WBRT). Patients treated with the MTX regimen had an OS of 65 months; those treated with the MTX + WBRT regimen had an OS of 74 months. The Cox proportional hazards regression identified age and KPS as the only prognostic indicators to OS and PFS. Recursive partitioning analysis categorized the patients into three groups according to these prognostic factors. Patients with KPS ≥ 70 had a favorable outcome compared to patients with KPS < 70. This held true especially for patients age 60 and younger, whose median OS was 100 months. Conclusions: The survival and prognostic indicators approximate those reported previously and provide independent validation for a simple yet powerful prognostic model that uses age and KPS to predict survival. [Table: see text]