Journal of Clinical Oncology, Vol 21, Issue 22
(November), 2003: 4151-4156
© 2003 American Society for Clinical Oncology
Intensive Methotrexate and Cytarabine Followed by High-Dose Chemotherapy With Autologous Stem-Cell Rescue in Patients With Newly Diagnosed Primary CNS Lymphoma: An Intent-to-Treat Analysis
Lauren E. Abrey,
Craig H. Moskowitz,
Warren P. Mason,
Michael Crump,
Douglas Stewart,
Peter Forsyth,
Nina Paleologos,
Denise D. Correa,
Nicole D. Anderson,
Dawn Caron,
Andrew Zelenetz,
Stephen D. Nimer,
Lisa M. DeAngelis
From the Departments of Neurology and Medicine and the Office of Clinical Research, Memorial Sloan-Kettering Cancer Center, New York, NY; Princess Margaret Hospital, University of Toronto, Toronto; Tom Baker Cancer Center, University of Calgary, Calgary, Canada; and the Department of Neurology, Evanston Hospital, Northwestern University, Chicago, IL.
Address reprint requests to Lauren Abrey, MD, Memorial Sloan-Kettering Cancer Center, Department of Neurology, 1275 York Ave, New York, NY 10021; e-mail: abreyl{at}mskcc.org.
Purpose: To assess the safety and efficacy of intensive methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma (PCNSL).
Patients and Methods: Twenty-eight patients received induction chemotherapy using high-dose systemic methotrexate (3.5 g/m2) and cytarabine (3 g/m2 daily for 2 days). Fourteen patients with chemosensitive disease evident on neuroimaging then received high-dose therapy using carmustine, etoposide, cytarabine, and melphalan with autologous stem-cell rescue.
Results: The objective response rate to the induction-phase chemotherapy was 57%, and median overall survival is not yet assessable, with a median follow-up time of 28 months. The overall median event-free survival time is 5.6 months for all patients and 9.3 months for 14 patients who underwent transplantation. Six of these 14 patients (43%) remained disease-free at last follow-up. Treatment was well tolerated; there was one transplantation-related death. Prospective neuropsychologic evaluations have revealed no evidence of treatment-related neurotoxicity.
Conclusion: This treatment approach is feasible in patients with newly diagnosed PCNSL without evidence of significant related neurotoxicity. Although the transplantation results are similar to those achieved in patients with aggressive or poor-prognosis systemic lymphoma, the low response rate to induction chemotherapy and the significant number of patients who experienced relapse soon after HDT suggest that more aggressive induction chemotherapy may be warranted.
Presented in part at the 37th American Society of Clinical Oncology Annual Meeting, San Francisco, CA, May 12–15, 2001.
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Facebook  Reddit  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
M. Sierra del Rio, A. Rousseau, C. Soussain, D. Ricard, and K. Hoang-Xuan
Primary CNS Lymphoma in Immunocompetent Patients
Oncologist,
May 1, 2009;
14(5):
526 - 539.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Schlegel
Review: Primary CNS lymphoma
Therapeutic Advances in Neurological Disorders,
March 1, 2009;
2(2):
93 - 104.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. Soussain, K. Hoang-Xuan, L. Taillandier, E. Fourme, S. Choquet, F. Witz, O. Casasnovas, B. Dupriez, B. Souleau, A.-L. Taksin, et al.
Intensive Chemotherapy Followed by Hematopoietic Stem-Cell Rescue for Refractory and Recurrent Primary CNS and Intraocular Lymphoma: Societe Francaise de Greffe de Moelle Osseuse-Therapie Cellulaire
J. Clin. Oncol.,
May 20, 2008;
26(15):
2512 - 2518.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Illerhaus, F. Muller, F. Feuerhake, A.-O. Schafer, C. Ostertag, and J. Finke
High-dose chemotherapy and autologous stem-cell transplantation without consolidating radiotherapy as first-line treatment for primary lymphoma of the central nervous system
Haematologica,
January 1, 2008;
93(1):
147 - 148.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Illerhaus, R. Marks, G. Ihorst, R. Guttenberger, C. Ostertag, G. Derigs, N. Frickhofen, F. Feuerhake, B. Volk, and J. Finke
High-Dose Chemotherapy With Autologous Stem-Cell Transplantation and Hyperfractionated Radiotherapy As First-Line Treatment of Primary CNS Lymphoma
J. Clin. Oncol.,
August 20, 2006;
24(24):
3865 - 3870.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Batchelor and J. S. Loeffler
Primary CNS Lymphoma
J. Clin. Oncol.,
March 10, 2006;
24(8):
1281 - 1288.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. DeAngelis and F. M. Iwamoto
An Update on Therapy of Primary Central Nervous System Lymphoma
Hematology,
January 1, 2006;
2006(1):
311 - 316.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. D. Doolittle, L. E. Abrey, W. A. Bleyer, S. Brem, T. P. Davis, P. Dore-Duffy, L. R. Drewes, W. A. Hall, J. M. Hoffman, A. Korfel, et al.
New Frontiers in Translational Research in Neuro-oncology and the Blood-Brain Barrier: Report of the Tenth Annual Blood-Brain Barrier Disruption Consortium Meeting
Clin. Cancer Res.,
January 15, 2005;
11(2):
421 - 428.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. T. Batchelor, B. R. Buchbinder, and N. L. Harris
Case 1-2005 - A 35-Year-Old Woman with Difficulty Walking, Headache, and Nausea
N. Engl. J. Med.,
January 13, 2005;
352(2):
185 - 194.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M.P. Omuro, L. M. DeAngelis, J. Yahalom, and L. E. Abrey
Chemoradiotherapy for primary CNS lymphoma: An intent-to-treat analysis with complete follow-up
Neurology,
January 11, 2005;
64(1):
69 - 74.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. DeAngelis
Primary Central Nervous System Lymphoma: A Curable Brain Tumor
J. Clin. Oncol.,
December 15, 2003;
21(24):
4471 - 4473.
[Full Text]
[PDF]
|
|
|
|
