Treatment > Methotrexate  

Meeting Abstract

Chemotherapy +/- whole-brain irradiation (WBI) for primary CNS lymphoma (PCNSL) - first experience with a randomized trial

A. Korfel, M.R. Nowrousian Sr., D. K Hossfeld Sr., W. Weber Sr., J. Brücher, W. E Berdel Sr., J. Birkmann Sr., Ch. Peschel, R. Pasold, B. Gleissner, L. Fischer, E. Thiel

Klinikum Benjamin Franklin, Berlin, Germany; Universitätsklinikum, Essen, Germany; Universitätskrankenhaus Eppendorf, Hamburg, Germany; Brüderkrankenhaus, Trier, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; Westfälische Wilhelms-Universität, Münster, Germany; Klinikum Nürnberg Nord, Nürnberg, Germany; Klinik rechts der Isar, München, Germany; Klinikum Ernst von Bergmann, Potsdam, Germany

The prognosis of nonimmunocompromised patients with PCNSL can be improved by high-dose methotrexate-based chemotherapy (HD-MTX CHT) as compared to WBI alone.
Late neurotoxicity is the major problem especially after combined treatment.
Eliminating WBI may diminish the risk of late neurotoxicity but result in an increased relapse rate.
Our trial addresses the role of adjuvant WBI after CHT in primary management of PCNSL.
The primary CHT regimen (BMPD) incorporated BCNU 80 mg/m2 d1, procarbacine 100 mg/m2 d1-8 and MTX 1.5 g/m2/24h d2.
Dexamethasone and intrathecal MTX were given in course 1 only.
Idarubicine 12 mg/m2 d1 and ifosfamide 3g/m2 d2 or high-dose cytarabine (HD-AraC) 2x3g/m2 d1-2 was given to patients without CR after BMPD.
Patients in CR after CHT were randomly assigned to WBI with 45 Gy or one additional CHT course.
Patients without CR were treated by rescue WBI.
Fifty-five patients were included.
Responses to BMPD were as follows: CR in 29, PR in 9, SD in 4 and PD in 7 patients.
No response evaluation was performed in 6 patients: 4 died during therapy and 2 dropped out.
Fourteen patients were treated with salvage CHT: 4 achieved a CR and 10 had PD.
CHT induced a CR in a total of 33 (60%) patients and PR in 4 (7%) patients.
The disease progressed in 12 (22%) and was not avaluable in 6 (11%) patients.
Seven of 11 (64%) patients responded to rescue WBI.
Only 26 patients were randomized:14 in CHT and 12 in WBI.
After a median follow-up of 11 months (range 0.5-27+) median overall survival was not reached (range 0.5-25+) and median time to progression was 9.9 months (0.5-25+).
Leukopenia and thrombopenia WHO grade 3-4 occurred in 36 and 24 patients, respectively.
Infection WHO grade 3-4 occurred in 17 patients.
Four patients died during therapy due to sepsis and one due to cerebral bleeding.
The study was closed prematurely because of low accrual and randomisation rate.
We will present updated results as well as survival analysis of patients with immediate adjuvant WBI as compared to patients with WBI at relapse.
The role of WBI in PCNSL is now being evaluated in a phase IV trial with only HD-MTX in primary therapy and randomized rescue treatment with WBI versus HD-Ara.

© Copyright 2002 American Society of Clinical Oncology