Journal article
First-line treatment and outcome of elderly patients with primary central nervous system lymphoma (PCNSL)--a systematic review and individual patient data meta-analysis.
- Kasenda B Department of Oncology, University Hospital of Basel, Basel Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland benjamin.kasenda@gmail.com benjamin.kasenda@rmh.nhs.uk.
- Ferreri AJ Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy.
- Marturano E Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy.
- Forst D Partners Neurology Residency Program, Harvard Medical School, Boston, USA.
- Bromberg J Department of Neuro-Oncology, Daniel den Hoed Cancer Center, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
- Ghesquieres H Department of Hematology, Centre Léon Bérard, University of Lyon, Lyon.
- Ferlay C Department of Hematology, Centre Léon Bérard, University of Lyon, Lyon.
- Blay JY Department of Hematology, Centre Léon Bérard, University of Lyon, Lyon.
- Hoang-Xuan K Department of Neurology Mazarin, LOC National Expert Center, APHP, IHU, UPMC, CRICM, GH Pitié-Salpêtrière, Paris, France.
- Pulczynski EJ Department of Haematology, Nordic Lymphoma Group, University Hospital Aarhus, Aarhus, Denmark.
- Fosså A Norwegian Department of Oncology, Nordic Lymphoma Group, Radium Hospital, Oslo, Norway.
- Okoshi Y Faculty of Medicine, Department of Hematology, University of Tsukuba, Tsukuba, Japan.
- Chiba S Faculty of Medicine, Department of Hematology, University of Tsukuba, Tsukuba, Japan.
- Fritsch K Department of Hematology/Oncology, University Hospital Freiburg, Freiburg, Germany.
- Omuro A Department of Neurology Mazarin, LOC National Expert Center, APHP, IHU, UPMC, CRICM, GH Pitié-Salpêtrière, Paris, France.
- O'Neill BP Department of Neurology, Mayo Medical School, Rochester, USA.
- Bairey O Institute of Hematology, Rabin Medical Center, Beilinson Hospital, Tel Aviv Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Schandelmaier S Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
- Gloy V Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
- Bhatnagar N Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
- Haug S Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg.
- Rahner S Medical Faculty, University of Freiburg, Freiburg, Germany.
- Batchelor TT Partners Neurology Residency Program, Harvard Medical School, Boston, USA Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, USA.
- Illerhaus G Stuttgart Cancer Center, Eva-Mayr-Stihl Tumor Center, Stuttgart, Germany.
- Briel M Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
- 2015-02-22
Published in:
- Annals of oncology : official journal of the European Society for Medical Oncology. - 2015
PCNSL
elderly patients
individual patient data meta-analysis
primary central nervous system lymphoma
systematic review
Aged
Antimetabolites, Antineoplastic
Central Nervous System Neoplasms
Humans
Lymphoma
Methotrexate
Prognosis
Survival Rate
English
BACKGROUND
To investigate prognosis and effects of first-line therapy in elderly primary central nervous system lymphoma (PCNSL) patients.
PATIENTS AND METHODS
A systematic review of studies about first-line therapy in immunocompetent patients ≥60 years with PCNSL until 2014 and a meta-analysis of individual patient data from eligible studies and international collaborators were carried out.
RESULTS
We identified 20 eligible studies; from 13 studies, we obtained individual data of 405 patients, which were pooled with data of 378 additional patients (N = 783). Median age and Karnofsky Performance Score (KPS) was 68 years (range: 60-90 years) and 60% (range: 10%-100%), respectively. Treatments varied greatly, 573 (73%) patients received high-dose methotrexate (HD-MTX)-based therapy. A total of 276 patients received whole-brain radiotherapy (median 36 Gy, range 28.5-70 Gy). KPS ≥ 70% was the strongest prognostic factor for mortality [hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.41-0.62]. After a median follow-up of 40 months, HD-MTX-based therapy was associated with improved survival (HR 0.70, 95% CI 0.53-0.93). There was no difference between HD-MTX plus oral chemotherapy and more aggressive HD-MTX-based therapies (HR 1.39, 95% CI 0.90-2.15). Radiotherapy was associated with an improved survival, but correlated with an increased risk for neurological side-effects (odds ratio 5.23, 95% CI 2.33-11.74).
CONCLUSIONS
Elderly PCNSL patients benefit from HD-MTX-based therapy, especially if combined with oral alkylating agents. More aggressive HD-MTX protocols do not seem to improve outcome. WBRT may improve outcome, but is associated with increased risk for neurological side-effects. Prospective trials for elderly PCNSL patients are warranted.
To investigate prognosis and effects of first-line therapy in elderly primary central nervous system lymphoma (PCNSL) patients.
PATIENTS AND METHODS
A systematic review of studies about first-line therapy in immunocompetent patients ≥60 years with PCNSL until 2014 and a meta-analysis of individual patient data from eligible studies and international collaborators were carried out.
RESULTS
We identified 20 eligible studies; from 13 studies, we obtained individual data of 405 patients, which were pooled with data of 378 additional patients (N = 783). Median age and Karnofsky Performance Score (KPS) was 68 years (range: 60-90 years) and 60% (range: 10%-100%), respectively. Treatments varied greatly, 573 (73%) patients received high-dose methotrexate (HD-MTX)-based therapy. A total of 276 patients received whole-brain radiotherapy (median 36 Gy, range 28.5-70 Gy). KPS ≥ 70% was the strongest prognostic factor for mortality [hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.41-0.62]. After a median follow-up of 40 months, HD-MTX-based therapy was associated with improved survival (HR 0.70, 95% CI 0.53-0.93). There was no difference between HD-MTX plus oral chemotherapy and more aggressive HD-MTX-based therapies (HR 1.39, 95% CI 0.90-2.15). Radiotherapy was associated with an improved survival, but correlated with an increased risk for neurological side-effects (odds ratio 5.23, 95% CI 2.33-11.74).
CONCLUSIONS
Elderly PCNSL patients benefit from HD-MTX-based therapy, especially if combined with oral alkylating agents. More aggressive HD-MTX protocols do not seem to improve outcome. WBRT may improve outcome, but is associated with increased risk for neurological side-effects. Prospective trials for elderly PCNSL patients are warranted.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1093/annonc/mdv076
- PMID 25701456
- Persistent URL
- https://folia.unifr.ch/global/documents/232550
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