[Clinical characteristics and prognosis of 52 patients with primary central nervous system lymphoma]

Objective: To investigate the clinical characteristics, treatment and prognostic factors in patients with primary central nervous system lymphoma (PCNSL) . Methods: This retrospective study included 52 patients with PCNSL treated in Peking University Third Hospital between January 2013 and December 2023. An analysis was conducted on the clinical characteristics, treatment and prognostic factors of the patients. Univariate and multivariate Cox proportional hazards models were used to determine factors associated with progression-free survival and overall survival (OS) . Results: In the overall cohort, the median age at diagnosis was 57 (range, 23-87) years, with a male/female ratio of 1.08:1. Neurological dysfunction (71.2%) and intracranial hypertension (57.7%) were common clinical manifestations. The tumors involved the deep brain tissue and presented as multifocal lesions. Treatment efficacy was evaluable in 49 patients, with a median follow-up of 23 (95% CI: 8.6-37.4) months. The 2- and 5-year PFS rates were 56.4% (95% CI: 42.2%-68.3%) and 36.3% (95% CI: 17.3%-53.4%), respectively, whereas the OS rates were 75.5% (95% CI: 61.7%-87.2%) and 66.0% (95% CI: 43.9%-78.3%), respectively. By univariate Cox regression analysis, age >60 years (HR=3.436, 95% CI: 1.008-11.710, P=0.049) and Memorial Sloan-Kettering Cancer Center grade 3 tumor (HR=22.10, 95% CI: 4.736 - 103.400, P< 0.001) were prognostic factors for worse OS, whereas auto-hematopoietic stem cell transplantation (HSCT) as consolidation therapy was significantly associated with longer OS (HR=0.223, 95%CI: 0.077-0.643, P=0.006). By multivariate Cox regression analysis, high-dose methotrexate chemotherapy (HR=0.082, 95%CI: 0.008-0.873, P=0.038) and auto-HSCT (HR=0.151, 95%CI: 0.030-0.747, P= 0.020) were independent predictors of prolonged OS. Conclusion: The prognosis was poor in patients with PCNSL who are elderly and those at high risk according to risk stratification. Adopting treatment regimens containing high-dose methotrexate and performing auto-HSCT can improve survival in patients with PCNSL.