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High-dose methotrexate for elderly patients with primary CNS lymphoma
Jay-Jiguang Zhu1, Elizabeth R Gerstner, David A Engler
1Department of Neurology, Tufts-New England Medical Center, Boston, MA, USA.
Neuro-Oncology
|September 2, 2008
Summary
High-dose methotrexate chemotherapy shows high response rates and low severe toxicity in elderly patients with primary CNS lymphoma. This treatment is a viable option for older individuals diagnosed with PCNSL.
Area of Science:
- Neuro-oncology
- Geriatric Medicine
- Clinical Pharmacology
Background:
- Methotrexate (MTX)-based chemotherapy has improved survival for primary CNS lymphoma (PCNSL).
- Older age is a negative prognostic factor in PCNSL and may increase MTX toxicity risk.
- Limited data exists on high-dose MTX efficacy and safety in elderly PCNSL patients (>=70 years).
Purpose of the Study:
- To evaluate the response and adverse effects of intravenous high-dose MTX in patients aged 70 years or older with PCNSL.
- To determine the feasibility of high-dose MTX as an initial therapy in this elderly population.
Main Methods:
- Retrospective analysis of 31 patients (>=70 years) with PCNSL treated with high-dose MTX (3.5-8 g/m(2)) from 1992-2006.
- Response assessed by contrast-enhanced MRI; toxicity evaluated via chart review.
- Analysis included dose reductions, radiographic response rates, progression-free survival (PFS), overall survival (OS), and toxicity grading.
Main Results:
- Median patient age was 74 years; 303 MTX cycles were administered (median 8 per patient).
- 87.9% of cycles required dose reduction due to renal function; 96.7% radiographic response rate (60% complete, 36.7% partial).
- Median PFS was 7.1 months, median OS was 37 months. Grade III/IV toxicities were low (GI 3.2%, hematological 6.5%, renal 0%).
Conclusions:
- High-dose MTX demonstrates a high radiographic response rate and acceptable toxicity profile in elderly PCNSL patients (>=70 years).
- Intravenous high-dose MTX is a feasible and effective treatment option for initial therapy in older adults with PCNSL.
- Further research may explore optimizing MTX dosing and supportive care in this demographic.
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