Journal of Clinical Oncology, Vol 9, 1580-1590, Copyright © 1991 by American Society of Clinical Oncology

ARTICLES

Primary CNS lymphoma treated with osmotic blood-brain barrier disruption: prolonged survival and preservation of cognitive function

EA Neuwelt, DL Goldman, SA Dahlborg, J Crossen, F Ramsey, S Roman-Goldstein, R Braziel and B Dana
Department of Neurology, Oregon Health Sciences University, Portland 97201-3098.

Combination chemotherapy with or without radiotherapy has had only modest efficacy in the treatment of primary CNS lymphoma. Median survival of these patients, treated primarily with radiotherapy, is 13 months; 5-year survival is less than 5%. Thirty consecutive non- acquired immune deficiency syndrome patients with primary CNS lymphoma were treated with barrier-dependent chemotherapy using intraarterial mannitol to open the blood-brain barrier (BBB). Follow-up included extensive neuropsychologic testing of all patients. Thirteen patients received cranial radiation 1 to 9 months before referral (group 1). Seventeen patients received initial BBB disruption chemotherapy with subsequent radiation only for tumor progression or recurrence (group 2). The difference in median survivals from diagnosis--17.8 months for group 1 and 44.5 months for group 2--was statistically significant (P = .039). Group 1 survival is comparable with the 20-month median survival of a historical series of patients (n = 208) treated with radiotherapy with or without chemotherapy. Group 2 patient survival represents an advance in the survival of CNS lymphoma and was associated with preservation of cognitive function in six of seven nonirradiated complete responders observed for 1 to 7 years. Patient toxicity was manageable in this intensive therapeutic regimen. In this series, a plateau in survival curves suggests that a major portion of these patients may be cured without the neuropsychologic sequelae associated with cranial radiation.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				L. Angelov, N. D. Doolittle, D. F. Kraemer, T. Siegal, G. H. Barnett, D. M. Peereboom, G. Stevens, J. McGregor, K. Jahnke, C. A. Lacy, et al. Blood-Brain Barrier Disruption and Intra-Arterial Methotrexate-Based Therapy for Newly Diagnosed Primary CNS Lymphoma: A Multi-Institutional Experience J. Clin. Oncol., July 20, 2009; 27(21): 3503 - 3509. [Abstract] [Full Text] [PDF]

				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]

				K. Jahnke, L. L. Muldoon, C. G. Varallyay, S. J. Lewin, R. D. Brown, D. F. Kraemer, C. Soussain, and E. A. Neuwelt Efficacy and MRI of rituximab and methotrexate treatment in a nude rat model of CNS lymphoma Neuro-oncol, January 1, 2009; 11(5): 503 - 513. [Abstract] [Full Text] [PDF]

				R. Yamanaka, K. Morii, Y. Shinbo, J. Homma, M. Sano, N. Tsuchiya, N. Yajima, T. Tamura, H. Hondoh, H. Takahashi, et al. Results of Treatment of 112 Cases of Primary CNS Lymphoma Jpn. J. Clin. Oncol., May 1, 2008; 38(5): 373 - 380. [Abstract] [Full Text] [PDF]

				D. Correa, L Maron, H Harder, M Klein, C. Armstrong, P Calabrese, J. Bromberg, L. Abrey, T. Batchelor, and D Schiff Cognitive functions in primary central nervous system lymphoma: literature review and assessment guidelines Ann. Onc., July 1, 2007; 18(7): 1145 - 1151. [Abstract] [Full Text] [PDF]

				L. L. Muldoon, C. Soussain, K. Jahnke, C. Johanson, T. Siegal, Q. R. Smith, W. A. Hall, K. Hynynen, P. D. Senter, D. M. Peereboom, et al. Chemotherapy Delivery Issues in Central Nervous System Malignancy: A Reality Check J. Clin. Oncol., June 1, 2007; 25(16): 2295 - 2305. [Abstract] [Full Text] [PDF]

				C. Soussain, L. L. Muldoon, C. Varallyay, K. Jahnke, L. DePaula, and E. A. Neuwelt Characterization and Magnetic Resonance Imaging of a Rat Model of Human B-Cell Central Nervous System Lymphoma Clin. Cancer Res., April 15, 2007; 13(8): 2504 - 2511. [Abstract] [Full Text] [PDF]

				C.-H. Hsieh, Y.-F. Chen, F.-D. Chen, J.-J. Hwang, J.-C. Chen, R.-S. Liu, J.-J. Kai, C.-W. Chang, and H.-E. Wang Evaluation of Pharmacokinetics of 4-Borono-2-18F-Fluoro-L-Phenylalanine for Boron Neutron Capture Therapy in a Glioma-Bearing Rat Model with Hyperosmolar Blood-Brain Barrier Disruption J. Nucl. Med., November 1, 2005; 46(11): 1858 - 1865. [Abstract] [Full Text] [PDF]

				E. T. Wong Management of Central Nervous System Lymphomas Using Monoclonal Antibodies: Challenges and Opportunities Clin. Cancer Res., October 1, 2005; 11(19): 7151s - 7157s. [Abstract] [Full Text] [PDF]

				T. N. Shenkier, J.-Y. Blay, B. P. O'Neill, P. Poortmans, E. Thiel, K. Jahnke, L. E. Abrey, E. Neuwelt, R. Tsang, T. Batchelor, et al. Primary CNS Lymphoma of T-Cell Origin: A Descriptive Analysis From the International Primary CNS Lymphoma Collaborative Group J. Clin. Oncol., April 1, 2005; 23(10): 2233 - 2239. [Abstract] [Full Text] [PDF]

				E. A. Neuwelt, P. E. Guastadisegni, P. Varallyay, and N. D. Doolittle Imaging Changes and Cognitive Outcome in Primary CNS Lymphoma after Enhanced Chemotherapy Delivery AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 258 - 265. [Abstract] [Full Text] [PDF]

				H. Harder, H. Holtel, J. E.C. Bromberg, P. Poortmans, H. Haaxma-Reiche, H. C. Kluin-Nelemans, J. Menten, and M. J. van den Bent Cognitive status and quality of life after treatment for primary CNS lymphoma Neurology, February 24, 2004; 62(4): 544 - 547. [Abstract] [Full Text] [PDF]

				D. D. Correa, L. M. DeAngelis, W. Shi, H. Thaler, A. Glass, and L. E. Abrey Cognitive functions in survivors of primary central nervous system lymphoma Neurology, February 24, 2004; 62(4): 548 - 555. [Abstract] [Full Text] [PDF]

				P. M.P. Poortmans, H. C. Kluin-Nelemans, H. Haaxma-Reiche, M. Van't Veer, M. Hansen, P. Soubeyran, M. Taphoorn, J. Thomas, M. Van den Bent, M. Fickers, et al. High-Dose Methotrexate-Based Chemotherapy Followed by Consolidating Radiotherapy in Non-AIDS-Related Primary Central Nervous System Lymphoma: European Organization for Research and Treatment of Cancer Lymphoma Group Phase II Trial 20962 J. Clin. Oncol., December 15, 2003; 21(24): 4483 - 4488. [Abstract] [Full Text] [PDF]

				H. Ishikawa, M. Hasegawa, Y. Tamaki, K. Hayakawa, T. Akimoto, H. Sakurai, N. Mitsuhashi, H. Niibe, M. Tamura, and T. Nakano Comparable Outcomes of Radiation Therapy without High-dose Methotrexate for Patients with Primary Central Nervous System Lymphoma Jpn. J. Clin. Oncol., September 1, 2003; 33(9): 443 - 449. [Abstract] [Full Text] [PDF]

				L. Cucullo, N. Marchi, M. Marroni, V. Fazio, S. Namura, and D. Janigro Blood-Brain Barrier Damage Induces Release of {alpha}2-Macroglobulin Mol. Cell. Proteomics, April 1, 2003; 2(4): 234 - 241. [Abstract] [Full Text] [PDF]

				N. Marchi, V. Fazio, L. Cucullo, K. Kight, T. Masaryk, G. Barnett, M. Volgelbaum, M. Kinter, P. Rasmussen, M. R. Mayberg, et al. Serum Transthyretin Monomer as a Possible Marker of Blood-to-CSF Barrier Disruption J. Neurosci., March 1, 2003; 23(5): 1949 - 1955. [Abstract] [Full Text] [PDF]

				J. Biagi, R. G. MacKenzie, M. S. Lim, M. Sapp, and N. Berinstein Primary Hodgkin's disease of the CNS in an immunocompetent patient: A case study and review of the literature Neuro-oncol, October 1, 2000; 2(4): 239 - 243. [Abstract] [PDF]

				L. E. Abrey, J. Yahalom, and L. M. DeAngelis Treatment for Primary CNS Lymphoma: The Next Step J. Clin. Oncol., September 17, 2000; 18(17): 3144 - 3150. [Abstract] [Full Text] [PDF]

				S. Ng, M. A. Rosenthal, D. Ashley, and L. Cher High-dose methotrexate for primary CNS lymphoma in the elderly Neuro-oncol, January 1, 2000; 2(1): 40 - 44. [Abstract] [PDF]

				B. P. O'Neill, C.-H. Wang, J. R. O'Fallon, J. P. Colgan, J. D. Earle, R. L. Krigel, L. D. Brown, and W. J. McGinnis The consequences of treatment and disease in patients with primary CNS non-Hodgkin's lymphoma: Cognitive function and performance status Neuro-oncol, July 1, 1999; 1(3): 196 - 203. [Abstract] [PDF]

				E. A. Neuwelt, R. E. Brummett, N. D. Doolittle, L. L. Muldoon, R. A. Kroll, M. A. Pagel, R. Dojan, V. Church, L. G. Remsen, and J. S. Bubalo First Evidence of Otoprotection Against Carboplatin-Induced Hearing Loss with a Two-Compartment System in Patients with Central Nervous System Malignancy Using Sodium Thiosulfate J. Pharmacol. Exp. Ther., July 1, 1998; 286(1): 77 - 84. [Abstract] [Full Text]

				M. A. Samuels and S. de la Monte Case 36-1994- A 49-Year-Old Man with Hypopituitarism, Multifocal Neurologic Defects, and an Intracranial Mass N. Engl. J. Med., September 29, 1994; 331(13): 861 - 868. [Full Text]