Older patients with primary central nervous system lymphoma: Survival and prognostication across 20 U.S. cancer centers

Kevin A. David, Suchitra Sundaram, Seo Hyun Kim, Ryan Vaca, Yong Lin, Samuel Singer, Mary Kate Malecek, Jordan Carter, Adam Zayac, Myung Sun Kim, Nishitha Reddy, Douglas Ney, Alma Habib, Christopher Strouse, Jerome Graber, Veronika Bachanova, Sidra Salman, Jean Alyxa Vendiola, Nasheed Hossain, Mazie TsangAjay Major, David A. Bond, Prashasti Agrawal, Angel Mier-Hicks, Pallawi Torka, Priya Rajakumar, Parameswaran Venugopal, Stephanie Berg, Michael Glantz, Samuel A. Goldlust, Matthew Folstad, Pallavi Kumar, Thomas A. Ollila, Johnny Cai, Stephen Spurgeon, Alex Sieg, Joseph Cleveland, Julie Chang, Narendranath Epperla, Reem Karmali, Seema Naik, Peter Martin, Sonali M. Smith, James Rubenstein, Brad Kahl, Andrew M. Evens

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

There is a paucity of large-scale data delineating outcomes and prognostication of older patients with primary central nervous system lymphoma (PCNSL). We retrospectively analyzed 539 newly-diagnosed PCNSL patients ages ≥60 years across 20 U.S. academic centers. The median age was 70 years (range 60–88); at least one geriatric syndrome was present in 46%; the median Cumulative Index Ratings Scale-Geriatrics (CIRS-G) score was 6 (range, 0–27); and 36% had impairment in activities of daily living (ADL). The most common induction regimens were high-dose methotrexate (HD-MTX) ± rituximab; methotrexate, temozolomide, rituximab (MTR); and rituximab, methotrexate, procarbazine, vincristine (R-MPV). Overall, 70% of patients achieved remission, with 14% undergoing consolidative autologous stem cell transplant (ASCT) and 24% receiving maintenance. With 58-month median follow-up, median progression-free survival (PFS) and overall survival (OS) were 17 months (95% CI 13–22 months) and 43 months (95% CI 31–56 months), respectively. Three-year PFS and OS were highest with MTR (55% and 74%, respectively). With single-agent methotrexate ± rituximab, 3-year PFS and OS were 30% (p =.0002) and 47% (p =.0072). On multivariate analysis, increasing age at diagnosis and Cooperative Oncology Group (ECOG) performance status (PS) was associated with inferior PFS; age, hypoalbuminemia, higher CIRS-G score, and ECOG PS adversely affected OS. Among patients receiving maintenance, 3-year PFS was 65% versus 45% without maintenance (p = 0.02), with 3-year OS of 84% versus 61%, respectively (p =.0003). Altogether, outcomes in older PCNSL patients appeared optimized with HD-MTX combination induction regimens and maintenance therapy. Furthermore, several prognostic factors, including geriatric measures, were associated with inferior outcomes.

Original languageEnglish
Pages (from-to)900-912
Number of pages13
JournalAmerican Journal of Hematology
Volume98
Issue number6
DOIs
StatePublished - Jun 2023
Externally publishedYes

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