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High-dose methotrexate-based immuno-chemotherapy for elderly primary CNS lymphoma patients (PRIMAIN study)

To investigate immuno-chemotherapy for elderly immuno-competent patients (65 years) with newly diagnosed primary central nervous system lymphoma, we conducted a multicentre single-arm trial. One cycle consisted of rituximab (375 mg/m2, days 1, 15, 29), high-dose methotrexate (3 g/m2 days 2, 16, 30),...

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Hauptverfasser: Fritsch, Kristina (VerfasserIn) , Löw, Sarah (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 2017
In: Leukemia
Year: 2016, Jahrgang: 31, Heft: 4, Pages: 846-852
ISSN:1476-5551
DOI:10.1038/leu.2016.334
Online-Zugang:Verlag, Volltext: http://dx.doi.org/10.1038/leu.2016.334
Verlag, Volltext: https://www.nature.com/articles/leu2016334
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Verfasserangaben:K. Fritsch, B. Kasenda, E. Schorb, P. Hau, J. Bloehdorn, R. Möhle, S. Löw, M. Binder, J. Atta, U. Keller, H.-H. Wolf, S. W. Krause, G. Heß, R. Naumann, S. Sasse, C. Hirt, M. Lamprecht, U. Martens, A. Morgner, J. Panse, N. Frickhofen, A. Röth, C. Hader, M. Deckert, H. Fricker, G. Ihorst, J. Finke and G. Illerhaus

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520 |a To investigate immuno-chemotherapy for elderly immuno-competent patients (65 years) with newly diagnosed primary central nervous system lymphoma, we conducted a multicentre single-arm trial. One cycle consisted of rituximab (375 mg/m2, days 1, 15, 29), high-dose methotrexate (3 g/m2 days 2, 16, 30), procarbazine (60 mg/m2 days 2-11) and lomustine (110 mg/m2, day 2)—R-MPL protocol. Owing to infectious complications, we omitted lomustine during the study and consecutive patients were treated with the R-MP protocol. Three cycles were scheduled and repeated on day 43. Subsequently, patients commenced 4 weekly maintenance treatment with procarbazine (100 mg for 5 days). Primary end point was complete remission (CR) after 3 cycles. We included 107 patients (69 treated with R-MPL and 38 with R-MP). In all, 38/107 patients achieved CR (35.5%) and 15 (14.0%) achieved partial remission. R-MP was associated with a lower CR rate (31.6%) compared with R-MPL (37.7%), but respective 2-year progression-free survival (All 37.3%; R-MP 34.9%; R-MPL 38.8%) and overall survival (All 47.0%; R-MP 47.7%; R-MPL 46.0%) rates were similar. R-MP was associated with less grade 3 toxicities compared with R-MPL (71.1% vs 87.0%). R-MP is more feasible while still associated with similar efficacy compared with R-MPL and warrants further improvement in future studies. 
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