Year-end Sale % OFF 
Abstract
This retrospective cohort study aimed to evaluate primary treatment and recent survival trends in patients with primary diffuse large B-cell lymphoma of central nervous system (CNS) from 1995 to 2016. Using the SEER data, patients diagnosed with non-HIV-associated primary central nervous system lymphoma (PCNSL)-diffuse large B-cell lymphoma (DLBCL) aged ⩾18 years between 1995 and 2016 were identified. The year of diagnosis was divided into the time period-1 (1995-2002), the time period-2 (2003-2012), and the time period-3 (2013-2016). Chi-square tests, the Kaplan-Meier method, log-rank test, and Cox regression model were used in the analysis. Overall, 3760 patients were included. Both the use of radiotherapy alone and the application of combined chemoradiotherapy decreased significantly, following the wider use of chemotherapy alone during 1995-2016. There was a significant improvement in PCNSL cause-specific survival (CSS) (period-1: 13 months vs. period-2: 19 months vs. period-3: 41 months, p<0.001). Survival of patients aged above 70 years did not change from the time period-1 to the time period-2 (p=0.101). However, there was an increase in CSS from the time period-2 to the time period-3 in the elderly patients (period-2: 5 months vs. period-3: 9 months, p<0.001). On multivariable analyses, diagnosed in the time period-3 was significantly and independently associated with better CSS (hazard ratio 0.577, 95% confidence interval 0.506-0.659, p<0.001). Our analysis shows the use of radiotherapy in the treatment of PCNSL has waned over the study span. There was a significant improvement in CSS during 1995-2016, which reflected developments in treatment over time. The elderly patient population also gained a significant CSS benefit in the most recent period.
Highlights
Primary central nervous system lymphoma (PCNSL) is among the most aggressive variants of extranodal non-Hodgkin lymphoma that involves the brain, leptomeninges, eyes, or spinal cord without evidence of systemic involvement[1]. 90%-95% of PCNSLs are pathologically diagnosed as diffuse large B‐cell lymphoma (DLBCL)[1, 2]
There was a significant improvement in PCNSL cancer-specific survival
Survival of patients aged above 70 years did not change from the time period-1 to the time period-2 (P = 0.101)
Summary
Primary central nervous system lymphoma (PCNSL) is among the most aggressive variants of extranodal non-Hodgkin lymphoma that involves the brain, leptomeninges, eyes, or spinal cord without evidence of systemic involvement[1]. 90%-95% of PCNSLs are pathologically diagnosed as diffuse large B‐cell lymphoma (DLBCL)[1, 2]. Whole-brain radiotherapy (WBRT) was regarded as the upfront treatment for PCNSL in the early 1990s and achieved a median overall survival (OS) of approximately 1 year[5]. In the 1990s, the HDMTX-based combination chemotherapy followed by additional consolidative WBRT was regarded ‘standard’ treatment for PCNSL by many researchers. The approach resulted in high response rate of more than 90%, median OS of 12– 60 months and 2-years OS of 60–85% in several prospective trials[6,7,8,9]. Based mainly on evidence of benefit in systemic CD20-positive lymphomas, rituximab is commonly administered along with high dose methotrexate (HDMTX)-based chemotherapy for PCNSL from the 2000s [14]. The efficacy of PD-1 checkpoint inhibitor for salvage therapy of PCNSL is being considered [20]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
