Isr Med Assoc J: Primary central nervous system lymphoma: clinical features, treatment options and treatment outcomes in 36 patients

Primary central nervous system lymphoma (PCNSL) is a rare form of aggressive non-Hodgkin lymphoma
.
Aggressive variant of non-Hodgkin lymphoma, confined to the brain, meninges, eyes, and spinal cord, with no evidence of
systemic disease.
Most patients may not be able to accept the price of intensive and toxic therapy necessary to achieve the goal, leading to conservative management
.
Treatment of older patients is limited because high-dose chemotherapy combined with autologous transplantation is too toxic for these patients, whereas WBRT has harmful effects and affects survival
due to neurotoxic effects.
There are currently limited
data on PCNSL management outside of clinical trials.
Experience
with PCNSL regimens using three main high-dose methotrexate (HDMTX) regimens in one medical center is reported here.

The study conducted a retrospective review
of the medical records of patients diagnosed with PCNSL who were treated at Soroka Medical Center between 2007 and 2019.
The study included 36 patients with a median age of 64.
9 years, 33 patients received HDMTX backbone induction therapy, and 21 (58.
3%) received consolidation therapy
.

Across the cohort, 25 patients (75.
7%) achieved a complete response, with a mean progression-free survival (PFS) of 32±6.
9 months and a median overall survival (OS) of 59.
6±12.
4 months
.
More aggressive regimens such as a combination of rituximab, HDMTX, cytarabine, and thiosubstitute Paar had a better response5 (100%) CR, but also had higher side effects such as neutropenic fever5 (100%)
.
By age grouping analysis (young vs >60 years), PFS was 24.
2 vs 9.
3 months and OS was 64.
1 vs 19.
4 months
, respectively.

Overall, differences in CR and PFS favored more aggressive regimens, but the toxicity of multi-agent combinations was significantly higher
.
The prognosis in younger patients was better than in older patients, and the incidence of CR, PFS, and OS was higher, but it was not statistically significant
.
Overall treatment results are encouraging, although there is a real need for an adaptive approach to older patients and a balance
between effectiveness and side effects.

Original source:

Zektser M, Rabinovich A, Grinbaum U, Porges T, Gozlan A, Gourevitch A, Al-Athamen K, Barrett O, Peles I, Kaisman-Elbaz T, Levi E.
Primary Central Nervous System Lymphoma: Clinical Characteristics, Treatment Options and Therapeutic Outcome in 36 Patients.
A Single Center Experience.
Isr Med Assoc J.
2022 Oct; 24(10):654-660.
PMID: 36309861.