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Multicenter Study
. 2025 Apr 24;18(1):48.
doi: 10.1186/s13045-025-01700-7.

PFS24 as a prognostic milestone in patients with newly diagnosed primary CNS lymphoma

Vanja Zeremski  1 , Tobias R Haage  2 , Hanno M Witte  3 , Louisa Adolph  4 , Sina A Beer  5 , Gerhard Behre  6 , Benedikt Jacobs  7 , Christoph Kahl  8   9 , Chrysavgi Lalayanni  10 , Jens Panse  11   12 , Sotirios Papageorgiou  13 , Marina P Siakantaris  14 , Jessica Schneider  15 , Ulf Schnetzke  16 , Alexander Schulz  6 , Theodoros P Vassilakopoulos  14 , Jeanette Walter  11   12 , Dimitrios Mougiakakos  2
Affiliations
Multicenter Study

PFS24 as a prognostic milestone in patients with newly diagnosed primary CNS lymphoma

Vanja Zeremski et al. J Hematol Oncol. .

Abstract

High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation has significantly improved overall survival (OS) in primary central nervous system lymphoma (PCNSL). However, early identification of long-term survivors remains a challenge. Progression-free survival at 24 months (PFS24) has emerged as a key prognostic marker in diffuse large B-cell lymphoma, but its relevance in PCNSL is still unclear. In this retrospective multicenter study, we analyzed data from 146 newly diagnosed, transplant-eligible PCNSL patients treated with MATRix-like regimens across 14 hospitals. With a median follow-up of 48 months, the 2-year PFS and OS rates were 50.4% and 65.6%, respectively. Of the 139 patients evaluable for PFS24-analysis, 51.1% reached PFS24, with a subsequent 5-year OS of 96.7%. Of note, the annual hazard rate for progression and death decreased to under 5% after 24 months, remaining stable thereafter. The patients who failed to reach PFS24 had a median OS of only 6.0 months. Key predictors of PFS failure included impaired Karnofsky performance status and treatment dose-reduction. In conclusion, PFS24 was identified as an important prognostic marker in PCNSL. Patients who achieve PFS24 have a favorable prognosis, whereas those who do not face poor outcomes and require innovative treatment approaches. This insight could aid in risk stratification and support the use of PFS24 as a surrogate endpoint in clinical trials.

Keywords: Overall survival; PFS24; Primary CNS lymphoma.

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Conflict of interest statement

Declarations. Ethical approval: All procedures were performed in accordance with the general ethical principles outlined in the Declaration of Helsinki. The study was carried out after approval of the Medical Faculty of the Otto von Guericke University Magdeburg, Magdeburg, Germany (approval no. 18/22). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Risk of relapse and/or death in fit patients diagnosed with PCNSL over time. (A) Smoothed hazard plots of death and progression over time. (B) Overall survival (OS) according to progression-free survival (PFS) time-points (PFS12, PFS24, PFS36)
See this image and copyright information in PMC

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