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High-dose methotrexate and rituximab induction regimen in immunocompetent patients with primary CNS lymphoma: a retrospective single-center study of survival predictors.
DeAtkine, Andrew B; Abdelrashid, Moaaz; Tucker, Zach; Mehta, Amitkumar; Markert, James M; Kim, Jinsuh; Fiveash, John B; Oster, Robert A; Lobbous, Mina; Nabors, L Burt.
Afiliação
  • DeAtkine AB; Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Abdelrashid M; Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Tucker Z; Division of Neuro-Oncology, Department of Neurology, University of Alabama at Birmingham, FOT 1020 | 510 20th Street South, Birmingham, AL, 35233, USA.
  • Mehta A; Division of Hematology and Oncology, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Markert JM; Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Kim J; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Fiveash JB; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Oster RA; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Lobbous M; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Nabors LB; Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
J Neurooncol ; 158(1): 33-40, 2022 May.
Article em En | MEDLINE | ID: mdl-35441948
ABSTRACT

PURPOSE:

Primary Central Nervous System Lymphoma (PCNSL) is an aggressive tumor that is confined to the CNS. Although the provision of high-dose methotrexate (HD-MTX) has remarkably improved outcomes in PCNSL patients, the optimal treatment regimens and standard MTX dose for induction therapy have been largely controversial. Herein, we sought to explore the impact of adjuvant rituximab and different dosages of induction HD-MTX on survival outcomes of immunocompetent patients with PCNSL.

METHODS:

In this study, we examined patients with PCNSL treated at a single NCI-designated comprehensive cancer center to evaluate their survival outcomes. We conducted a retrospective analysis of 51 immunocompetent patients with PCNSL who received their induction chemotherapy at the University of Alabama at Birmingham (UAB) between 2001 and 2019. Only adult patients with a confirmed diagnosis of PCNSL who had either HD-MTX alone or in combination with rituximab were included. Patients' demographics, clinical characteristics, and survival data were collected and analyzed.

RESULTS:

There is no significant difference in survival among patients who received MTX alone versus MTX plus rituximab (HR = 0.996 (95% CI 0.398-2.493), p = 0.994). Lower doses of MTX were associated with worse survival outcomes (HR = 0.680 (95% CI 0.530-0.872), p = 0.002); however, this difference in survival was not significant when adjusted to age (HR = 0.797 (95% CI 0.584-1.088), p = 0.153).

CONCLUSION:

Our experience challenges the role of rituximab in PCNSL during induction therapy. Our study also highlights the shorter survival in elderly patients with PCNSL which can be related, to some extent, to the relatively lower doses of HD-MTX. There is an unmet need to establish a consensus on the most effective upfront regimen in PCNSL through prospective studies.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias do Sistema Nervoso Central / Linfoma Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Humans Idioma: En Revista: J Neurooncol Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias do Sistema Nervoso Central / Linfoma Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Humans Idioma: En Revista: J Neurooncol Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Estados Unidos