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Primary
central nervous system lymphoma: the Massachusetts General Hospital experience,
1987-2001
Benjamin
E Lawler, Rebecca Betensky, Fred Hochberg, Tracy Batchelor
Dept of
Neurology, Massachusetts General Hospital and Harvard Medical School, Boston,
MA; Dept of Biostatistics, Harvard School of Public Health, Boston, MA
We
present a review of primary central nervous system lymphoma (PCNSL) patients
treated at our hospital over the past 14 years.
There were 51 consecutive, immunocompetent patients with at least one gadolinium
enhancing lesion in the brain and a diagnosis confirmed with either a brain or
vitreal biopsy, or cerebral spinal fluid (CSF) cytopathology.
48 of these initially received high dose intravenous methotrexate (MTX) at 3.5
g/m2 or 8.0 g/m2 alone or in combination with other agents.
Of the patients treated with MTX, 31 (64.5%) achieved CR and 7 (14.5%) achieved
PR, for a 79% overall response rate.
There were 15 deaths among the 48 patients with a median survival time of 90
months and a median follow-up time of 41 months.
Potential predictors of radiographic response and survival that were analyzed
included age, gender, ocular involvement, CSF protein level, positive CSF
cytopathology, serum lactic dehydrogenase (LDH) levels, cerebral location of
lesions and number of lesions.
None of these variables significantly predicted radiographic response or
survival.
However, elevated LDH was associated with a decreased rate of CR (p=0.073) and
was suggestive of decreased survival from the time of initial diagnosis
(p=0.079, hazard ratio 3.2).
Among patients who had radiographic responses (CR or PR), CR was associated with
increased survival from the time of that response (p=0.034, hazard ratio 0.2).
In summary, two-thirds of the patients treated at our institution achieved
radiographic CR with MTX-based chemotherapy (mainly MTX alone) and durable
survival has been achieved for most.
LDH was the only baseline variable associated with response and survival.
© Copyright 2002
American
Society of Clinical Oncology
Source:
http://www.asco.org/ac/1,1003,_12-002324-00_18-002002-00_19-00299-00_29-00A-00_42-00ONeill-00_43-00-00_44-00-00_45-00
Author-00_46-00Title-00_47-00Title-00_48-00and-00_49-00and,00.asp?cat=CNS+Tumors&parent=CENTRAL+NERVOUS+SYSTEM+TUMORS
&returnpid=2323 |
