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Chemotherapy Alone as Initial Treatment for Primary CNS Lymphoma in Patients Older Than 60 Years: A Multicenter Phase II Study (26952) of the European Organization for Research and Treatment of Cancer Brain Tumor Group

K. Hoang-Xuan, L. Taillandier, O. Chinot, P. Soubeyran, U. Bogdhan, J. Hildebrand, M. Frenay, N. De Beule, J.Y. Delattre, B. Baron

From the Fédération Neurologique Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris; Service de Neurologie, CHU Nancy; Service de Neurochirurgie, CHU La Timone, Marseille; Institut Bergonié, Bordeaux; Centre Antoine Lacassagne, Nice, France; Department of Neurology, Universität Klinik Regensburg, Germany; Service de Neurologie, Hôpital Erasme; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.

Address reprint requests to: K. Hoang-Xuan, MD, Fédération Neurologique Mazarin, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l’hôpital, 75651 Paris Cedex 13, France; email: khe.hoang-xuan{at}psl.ap-hop-paris.fr.

Purpose: To assess the efficacy and toxicity of chemotherapy alone in patients older than 60 years with primary CNS lymphoma.

Patients and Methods: Fifty patients with a median age of 72 years and a median Karnofsky performance score (KPS) of 50 were eligible for this multicenter phase II study. The protocol consisted of high-dose methotrexate (MTX), lomustine, procarbazine, methylprednisolone, and intrathecal chemotherapy with MTX and cytarabine. The patients received one induction cycle; if objective response was achieved, five additional maintenance cycles were administered every 6 weeks. The median follow-up of patients was 3 years.

Results: Twenty four patients (48%) achieved an objective response (compete response [CR], 42%; partial response, 6%), with a median duration of CR of 27 months (range, 3 to 47+ months). Overall median survival time was 14.3 months, and 1-year progression-free survival was 40% (95% confidence interval [CI], 26% to 53%). Myelosuppression was the most frequent side effect, with grade 3 to 4 neutropenia in 19% of patients. One patient died during chemotherapy, as a result of pulmonary embolism. Most patients improved or preserved their cognitive functions (47% and 45% of the patients, respectively) and KPS (36% and 52% of the patients, respectively) until relapse, whereas cognitive and KPS decline attributed to delayed treatment neurotoxicity occurred in 8% and 12% patients, respectively.

Conclusion: In the elderly, this chemotherapy regimen compares favorably with radiotherapy (RT) alone and reduces considerably the risk of delayed neurotoxicity associated with combined chemoradiotherapy. Chemotherapy alone is an appropriate strategy in older patients to delay or avoid RT.

Presented in part at the Fourth Meeting of the European Association of Neuro-Oncology (EANO), Copenhagen, Denmark, June 3–6, 2000.

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Related Correspondence

• Is Withdrawal of Consolidation Radiotherapy an Evidence-Based Strategy in Primary Central Nervous System Lymphomas?
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  JCO 2004 22: 1165-1167 [Full Text]

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• In Reply:
  K. Hoang-Xuan and J.Y. Delattre
  JCO 2004 22: 1167-1168 [Full Text]

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