Journal article
Older Patients with Primary Central Nervous System Lymphoma: Survival and Prognostication Across 20 US Cancer Centers
American journal of hematology, Vol.98(6), pp.900-912
06/2023
DOI: 10.1002/ajh.26919
PMCID: PMC10979647
PMID: 36965007
Abstract
There is a paucity of large-scale data delineating outcomes and prognostication of older patients with primary central nervous system lymphoma (PCNSL). We retrospectively analyzed 539 newly-diagnosed PCNSL patients ages ≥60 years across 20 US academic centers. Median age was 70 years (range 60-88); at least one geriatric syndrome was present in 46%; median Cumulative Index Ratings Scale-Geriatrics (CIRS-G) score was 6 (range 0-27); and 36% had impairment in at least one activities of daily living (ADL). The most common induction regimens were high-dose methotrexate +/- rituximab; methotrexate, temozolomide, rituximab (MTR); and rituximab, methotrexate, procarbazine, vincristine (R-MPV). Overall, 70% of patients achieved remission with 14% undergoing consolidative autologous stem cell transplant (ASCT), and 24% receiving maintenance. With 58-month median follow-up, median progression-free survival (PFS) and overall survival (OS) were 17 months (95% CI 13-22 months) and 43 months (95% CI 31-56 months), respectively. Three-year PFS and OS were highest with MTR (55% and 74%, respectively). Wiith single-agent methotrexate +/- rituximab, 3-year PFS and OS were 30% (p=.0002) and 47% (p=.0072), respectively. On multivariate analysis, increasing age at diagnosis and ECOG performance status (PS) were associated with inferior PFS, and age, hypoalbuminemia, higher CIRS-G score, and ECOG PS adversely affected OS. Among patients receiving maintenance, 3-year PFS was 65% versus 45% without maintenance (P=0.02), with 3-year OS of 84% vs. 61%, respectively (P=.0003). Altogether, outcomes in older PCNSL patients appeared optimized with high-dose methotrexate combination induction as well as maintenance. Furthermore, several prognostic factors, including geriatric measures, were associated with divergent outcomes. This article is protected by copyright. All rights reserved.
Details
- Title: Subtitle
- Older Patients with Primary Central Nervous System Lymphoma: Survival and Prognostication Across 20 US Cancer Centers
- Creators
- Kevin A David - Rutgers, The State University of New JerseySuchitra Sundaram - Roswell Park Cancer InstituteSeo-Hyun Kim - Rush University Medical CenterRyan Vaca - Pennsylvania State UniversityYong Lin - Rutgers, The State University of New JerseySamuel Singer - John Theurer Cancer CenterMary-Kate Malecek - Washington University in St. LouisJordan Carter - Rutgers Cancer Institute of New, JerseyAdam Zayac - Brown UniversityMyung Sun Kim - Oregon Health & Science UniversityNishitha Reddy - Vanderbilt UniversityDouglas Ney - University of ColoradoAlma Habib - University of MinnesotaChristopher Strouse - University of IowaJerome Graber - University of WashingtonVeronika Bachanova - University of MinnesotaSidra Salman - Loyola University Medical CenterJean Alyxa Vendiola - Loyola University Medical CenterNasheed Hossain - Loyola University Medical CenterMazie Tsang - University of California, San FranciscoAjay Major - University of ChicagoDavid A Bond - The Ohio State UniversityPrashasti Agrawal - Weill Cornell Medical CollegeAngel Mier-Hicks - Roswell Park Cancer InstitutePallawi Torka - Roswell Park Cancer InstitutePriya Rajakumar - Rush University Medical CenterParameswaran Venugopal - Rush University Medical CenterStephanie Berg - Loyola University Medical CenterMichael Glantz - Pennsylvania State UniversitySamuel A Goldlust - John Theurer Cancer CenterMatthew Folstad - University of WisconsinPallavi Kumar - Rutgers, The State University of New JerseyThomas A Ollila - Brown UniversityJohnny Cai - Oregon Health & Science UniversityStephen Spurgeon - Oregon Health & Science UniversityAlex Sieg - University of IowaJoseph Cleveland - University of California, San FranciscoJulie Chang - University of WisconsinNarendranath Epperla - The Ohio State UniversityReem Karmali - Northwestern UniversitySeema Naik - Pennsylvania State UniversityPeter Martin - Weill Cornell Medical CollegeSonali M Smith - University of ChicagoJames Rubenstein - University of California, San FranciscoBrad Kahl - Washington University in St. LouisAndrew M Evens - Rutgers, The State University of New Jersey
- Resource Type
- Journal article
- Publication Details
- American journal of hematology, Vol.98(6), pp.900-912
- DOI
- 10.1002/ajh.26919
- PMID
- 36965007
- PMCID
- PMC10979647
- NLM abbreviation
- Am J Hematol
- ISSN
- 0361-8609
- eISSN
- 1096-8652
- Language
- English
- Electronic publication date
- 03/25/2023
- Date published
- 06/2023
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984381137402771
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