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Long-term survival in primary CNS lymphoma
L E Abrey1, L M DeAngelis, J Yahalom
1Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Purpose:
We have previously reported on 31 patients with primary CNS lymphoma (PCNSL) treated between 1986 and 1992 with methotrexate (MTX), cranial radiotherapy (RT), and high-dose cytarabine who remained free of disease longer than historical controls.
Patients And Methods:
We performed a follow-up analysis of our original cohort and now report their long-term survival and late treatment-related toxicity.
Results:
The median cause-specific survival was 42 months, with a five-year survival of 22.3% compared with 3% to 4% in historical controls treated with RT alone. Age less than 50 years at diagnosis was a significant prognostic factor for survival (P = .01). Median disease-free survival was 40.3 months; 15 patients relapsed, all but one in the CNS. Late treatment-related toxicity was observed in nearly one third of patients and those more than 60 years of age were at substantially higher risk (P < .0001).
Conclusion:
Combined modality therapy for PCNSL has improved survival, but relapse is common and late neurologic toxicity is a significant complication. Although this approach is highly effective for younger patients, efficacious but less neurotoxic regimens need to be developed for older patients.