Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr;38(2):223-234.
doi: 10.1007/s12288-021-01444-7. Epub 2021 May 18.

Primary Central Nervous System Lymphoma: Long-Term Treatment Outcomes and Cost-Analysis from a Retrospective Study of High-Dose Methotrexate Based Chemoimmunotherapy and Reduced Dose Radiation Therapy Approach

Radhakrishnan Vs  1 , Podder D  1 , Mukherjee H  1 , Mandal P  1 , Achari R  2 , Sen S  3 , Dey D  4 , Arun I  4 , Latif Z  4 , Arora N  4 , Nag A  1 , Kumar J  1 , Javed R  1 , Bhave Sj  1 , Parihar M  4 , Mishra Dk  4 , Chandy M  1 , Nair R  1
Affiliations

Primary Central Nervous System Lymphoma: Long-Term Treatment Outcomes and Cost-Analysis from a Retrospective Study of High-Dose Methotrexate Based Chemoimmunotherapy and Reduced Dose Radiation Therapy Approach

Radhakrishnan Vs et al. Indian J Hematol Blood Transfus. 2022 Apr.

Abstract

Standard treatment of primary central nervous system lymphoma (PCNSL) in countries with limited resources remains conventional chemotherapy, with or without whole brain radiotherapy (WBRT). To evaluate the treatment outcomes, prognostic factors and costs in patients with PCNSL treated with high-dose Methotrexate, vincristine and procarbazine, plus Rituximab (MVP-R) followed by consolidation with reduced dose (rd) WBRT and Cytarabine chemotherapy. We conducted an institutional audit of the first line treatment of patients with PCNSL, who were treated with MVP-R regimen, WBRT, or both between September 2011 and January 2020. Long term neuro-cognitive toxicity was recorded on follow up. The 5-year overall survival (OS) was the primary end point. Of 54 patients, 42 were evaluable [median age: 54 years (19-73 years)]. The commonest subtype was activated B-cell subtype (90%). At presentation, multiple and deep brain lesions were reported in 38 and 73% patients, respectively. Combined chemoimmunotherapy was given to 41 patients and WBRT to 29 patients. 27 patients (65%) achieved a complete response, and 22 received rdWBRT. 7 patients with partial response received conventional dose WBRT. Among tested prognostic factors, response to treatment was the single most significant determinant. At a median follow-up of 58 months, the 5-year progression free survival was 42%, and 5-year OS was 60%. The median direct hospital costs incurred by most patients for investigations and treatment were $1976.45 and $12,078.49, respectively. MVP-R is a well-tolerated regimen with substantial long term outcomes. Among all prognostic factors, response to therapy is the most significant.

Keywords: Blood–brain barrier; CNS lymphoma; Diffuse large B cell; High dose methotrexate; Lymphoma; Real-world; Reduced dose whole brain radiotherapy; Rituximab.

PubMed Disclaimer

Conflict of interest statement

Conflicts of InterestProf Nair R has received research grants, advisory board fees as well as Speaker fee from Cipla, Freisenius Kabi, Johnson and Johnson, Mylan, Novartis, and Dr Reddy’s Laboratory. Dr. RADHAKRISHNAN V reports advisory fees (institutional) and non-financial Institutional support from PFIZER, Institutional grants and non-financial support from INTAS Pharmaceuticals, Institutional grants from NATCO Pharmaceuticals, Institutional grants from ROCHE, Institutional grants from BMS, Institutional grants and non-financial support from CIPLA Pharmaceuticals, Institutional grants from EMCURE, personal fees (institutional) from ASTRA ZENECA, non-financial institutional support from Dr. REDDY’s Laboratories, outside the submitted work. Other authors declare no relevant conflicts of interest with respect to the submitted work.

Figures

Fig. 1
Fig. 1
Treatment Flow-diagram
Fig. 2
Fig. 2
a PFS in PCNSL treated with MVP-R based regimen with response to treatment b 5-year PFS for PCNSL
Fig. 3
Fig. 3
a OS in PCNSL Gender b OS in PCNSL with age c OS in PCNSL with Solitary and multiple brain lesions d 5-year OS for PCNSL
Fig. 3
Fig. 3
a OS in PCNSL Gender b OS in PCNSL with age c OS in PCNSL with Solitary and multiple brain lesions d 5-year OS for PCNSL
See this image and copyright information in PMC

References

    1. Schultz C, Scott C, Sherman W, Donahue B, Fields J, Murray K, et al. Preirradiation chemotherapy with cyclophosphamide, doxorubicin, vincristine, and dexamethasone for primary CNS lymphomas: initial report of radiation therapy oncology group protocol 88–06. J Clin Oncol. 1996;14(2):556–564. doi: 10.1200/JCO.1996.14.2.556. - DOI - PubMed
    1. Gabbai AA, Hochberg FH, Linggood RM, Bashir R, Hotleman K (1989) High-dose methotrexate for non-AIDS primary central nervous system lymphoma. Report of 13 cases. J Neurosurg 70(2):190–4. - PubMed
    1. Glass J, Gruber ML, Cher L, Hochberg FH. Preirradiation methotrexate chemotherapy of primary central nervous system lymphoma: long-term outcome. J Neurosurg. 1994;81(2):188–195. doi: 10.3171/jns.1994.81.2.0188. - DOI - PubMed
    1. Morris PG, Correa DD, Yahalom J, Raizer JJ, Schiff D, Grant B, et al. Rituximab, methotrexate, procarbazine, and vincristine followed by consolidation reduced-dose whole-brain radiotherapy and cytarabine in newly diagnosed primary CNS lymphoma: final results and long-term outcome. J Clin Oncol. 2013;31(31):3971–3979. doi: 10.1200/JCO.2013.50.4910. - DOI - PMC - PubMed
    1. Ferreri AJ, Reni M, Foppoli M, Martelli M, Pangalis GA, Frezzato M, et al. High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomised phase 2 trial. Lancet. 2009;374(9700):1512–1520. doi: 10.1016/S0140-6736(09)61416-1. - DOI - PubMed

LinkOut - more resources