Immunochemotherapy with Intensive Consolidation for Primary CNS Lymphoma: A Pilot Study and Prognostic Assessment by Diffusion-Weighted MRI
| Autor: | Marc A. Shuman, Patrick A. Treseler, Matthew J. Wieduwilt, Samar Issa, Jimmy Hwang, James L. Rubenstein, Francisco Valles, Lloyd E. Damon, Caroline Behler, Soonmee Cha, Joan M. O'Brien, Michael W. McDermott |
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| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Oncology
Adult Male Cancer Research medicine.medical_specialty Lymphoma Dacarbazine medicine.medical_treatment Article Central Nervous System Neoplasms Antibodies Monoclonal Murine-Derived Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Temozolomide Humans Etoposide Aged Aged 80 and over Chemotherapy business.industry Remission Induction Primary central nervous system lymphoma Cytarabine Brain Consolidation Chemotherapy Middle Aged medicine.disease Prognosis Survival Analysis Surgery Regimen Diffusion Magnetic Resonance Imaging Methotrexate Treatment Outcome Rituximab Female Immunotherapy business medicine.drug |
| Popis: | Purpose: We evaluated a novel therapy for primary central nervous system lymphoma (PCNSL) with induction immunochemotherapy with high-dose methotrexate, temozolomide, and rituximab (MT-R) followed by intensive consolidation with infusional etoposide and high-dose cytarabine (EA). In addition, we evaluated the prognostic value of the minimum apparent diffusion coefficient (ADCmin) derived from diffusion-weighted MRI (DW-MRI) in patients treated with this regimen. Experimental Design: Thirty-one patients (median age, 61 years; median Karnofsky performance score, 60) received induction with methotrexate every 14 days for 8 planned cycles. Rituximab was administered the first 6 cycles and temozolomide administered on odd-numbered cycles. Patients with responsive or stable central nervous system (CNS) disease received EA consolidation. Pretreatment DW-MRI was used to calculate the ADCmin of contrast-enhancing lesions. Results: The complete response rate for MT-R induction was 52%. At a median follow-up of 79 months, the 2-year progression-free and overall survival were 45% and 58%, respectively. For patients receiving EA consolidation, the 2-year progression-free and overall survival were 78% and 93%, respectively. EA consolidation was also effective in an additional 3 patients who presented with synchronous CNS and systemic lymphoma. Tumor ADCmin less than 384 × 10–6 mm2/s was significantly associated with shorter progression-free and overall survival. Conclusions: MT-R induction was effective and well tolerated. MT-R followed by EA consolidation yielded progression-free and overall survival outcomes comparable to regimens with chemotherapy followed by whole-brain radiotherapy consolidation but without evidence of neurotoxicity. Tumor ADCmin derived from DW-MRI provided better prognostic information for PCNSL patients treated with the MTR-EA regimen than established clinical risk scores. Clin Cancer Res; 18(4); 1146–55. ©2012 AACR. |
| Databáze: | OpenAIRE |
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