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. 2020 Mar 10;94(10):e1027-e1039.
doi: 10.1212/WNL.0000000000008900. Epub 2020 Jan 6.

Management and outcome of primary CNS lymphoma in the modern era: An LOC network study

Caroline Houillier  1 , Carole Soussain  2 , Hervé Ghesquières  2 , Pierre Soubeyran  2 , Olivier Chinot  2 , Luc Taillandier  2 , Thierry Lamy  2 , Sylvain Choquet  2 , Guido Ahle  2 , Gandhi Damaj  2 , Philippe Agapé  2 , Cécile Moluçon-Chabrot  2 , Alexandra Amiel  2 , Vincent Delwail  2 , Michel Fabbro  2 , Fabrice Jardin  2 , Adrien Chauchet  2 , Marie-Pierre Moles-Moreau  2 , Franck Morschhauser  2 , Olivier Casasnovas  2 , Rémy Gressin  2 , Luc-Matthieu Fornecker  2 , Julie Abraham  2 , Jean-Pierre Marolleau  2 , Adrian Tempescul  2 , Chantal Campello  2 , Philippe Colin  2 , Jérôme Tamburini  2 , Kamel Laribi  2 , Caroline Serrier  2 , Corinne Haioun  2 , Safia Chebrek  2 , Anna Schmitt  2 , Marie Blonski  2 , Roch Houot  2 , Eileen Boyle  2 , Jacques-Olivier Bay  2 , Lucie Oberic  2 , Emeline Tabouret  2 , Agathe Waultier  2 , Nadine Martin-Duverneuil  2 , Valérie Touitou  2 , Nathalie Cassoux  2 , Aurélie Kas  2 , Karima Mokhtari  2 , Frederic Charlotte  2 , Agusti Alentorn  2 , Loïc Feuvret  2 , Magali Le Garff-Tavernier  2 , Myrto Costopoulos  2 , Bertrand Mathon  2 , Matthieu Peyre  2 , Daniel Delgadillo  2 , Hassen Douzane  2 , Diane Genet  2 , Bachir Aidaoui  2 , Khê Hoang-Xuan  2 , Emmanuel Gyan  2
Affiliations

Management and outcome of primary CNS lymphoma in the modern era: An LOC network study

Caroline Houillier et al. Neurology. .

Abstract

Objective: Real-life studies on patients with primary CNS lymphoma (PCNSL) are scarce. Our objective was to analyze, in a nationwide population-based study, the current medical practice in the management of PCNSL.

Methods: The French oculo-cerebral lymphoma network (LOC) database prospectively records all newly diagnosed PCNSL cases from 32 French centers. Data of patients diagnosed between 2011 and 2016 were retrospectively analyzed.

Results: We identified 1,002 immunocompetent patients (43% aged >70 years, median Karnofsky Performance Status [KPS] 60). First-line treatment was high-dose methotrexate-based chemotherapy in 92% of cases, with an increasing use of rituximab over time (66%). Patients <60 years of age received consolidation treatment in 77% of cases, consisting of whole-brain radiotherapy (WBRT) (54%) or high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) (23%). Among patients >60 years of age, WBRT and HCT-ASCT consolidation were administered in only 9% and 2%, respectively. The complete response rate to initial chemotherapy was 50%. Median progression-free survival was 10.5 months. For relapse, second-line chemotherapy, HCT-ASCT, WBRT, and palliative care were offered to 55%, 17%, 10%, and 18% of patients, respectively. The median, 2-year, and 5-year overall survival was 25.3 months, 51%, and 38%, respectively (<60 years: not reached [NR], 70%, and 61%; >60 years: 15.4 months, 44%, and 28%). Age, KPS, sex, and response to induction CT were independent prognostic factors in multivariate analysis.

Conclusions: Our study confirms the increasing proportion of elderly within the PCNSL population and shows comparable outcome in this population-based study with those reported by clinical trials, reflecting a notable application of recent PCNSL advances in treatment.

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Figures

Figure 1
Figure 1. Outcome according to age
(A) Progression-free survival (PFS). (B) Overall survival (OS).
Figure 2
Figure 2. Overall survival (OS) from relapse according to treatment at relapse
CT = chemotherapy; HCT-ASCT = high-dose chemotherapy with autologous stem cell transplantation; WBRT = whole-brain radiotherapy.
See this image and copyright information in PMC

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