Early response to high-dose methotrexate, vincristine, and procarbazine chemotherapy-adapted strategy for primary CNS lymphoma: no consolidation therapy for patients achieving early complete response.

Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9107334 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-0584 (Electronic) Linking ISSN: 09395555 NLM ISO Abbreviation: Ann Hematol Subsets: MEDLINE

Publication: Berlin : Springer Verlag
Original Publication: Berlin ; New York : Springer International, c1991-

Herpesvirus 4, Human* ; Stem Cell Transplantation*; Antineoplastic Combined Chemotherapy Protocols/*administration & dosage ; Brain Neoplasms/*therapy ; Epstein-Barr Virus Infections/*therapy ; Lymphoma/*therapy; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Autografts ; Brain Neoplasms/metabolism ; Brain Neoplasms/mortality ; Brain Neoplasms/pathology ; Brain Neoplasms/virology ; DNA, Viral/metabolism ; Disease-Free Survival ; Epstein-Barr Virus Infections/metabolism ; Epstein-Barr Virus Infections/mortality ; Epstein-Barr Virus Infections/pathology ; Female ; Follow-Up Studies ; Gene Expression Regulation, Neoplastic/drug effects ; Gene Expression Regulation, Neoplastic/radiation effects ; Gene Expression Regulation, Viral/drug effects ; Gene Expression Regulation, Viral/radiation effects ; Humans ; Lymphoma/metabolism ; Lymphoma/mortality ; Lymphoma/pathology ; Lymphoma/virology ; Male ; Methotrexate/administration & dosage ; Methotrexate/adverse effects ; Middle Aged ; Procarbazine/administration & dosage ; Procarbazine/adverse effects ; RNA, Viral/metabolism ; Retrospective Studies ; Survival Rate ; Vincristine/administration & dosage ; Vincristine/adverse effects

Optimal treatment strategies for primary central nervous system lymphoma (PCNSL) have not been established. In this study, we investigated the treatment outcomes and prognostic factors of high-dose methotrexate, vincristine, and procarbazine (MVP) chemotherapy followed by an interim response-adapted intensification strategy in immunocompetent patients with PCNSL. We evaluated the evidence of infection with Epstein-Barr virus (EBV) in both brain tumor tissue and whole blood. Forty patients were retrospectively reviewed. Ten (25 %) patients who achieved complete response (CR) in the interim analysis did not receive any additional consolidation treatment after completion of planned high-dose MVP chemotherapy. Additional radiotherapy (n = 9) or autologous stem cell transplantation (ASCT) (n = 7) was performed in patients who did not achieve CR in the interim analysis. The median age was 55 years. The overall CR rate was 62.5 % (n = 25), and the objective response rate was 75.0 %. Two-year overall survival (OS) was 59.8 %, and 2-year progression-free survival was 47.1 %. Grade 3 or 4 neutropenia and thrombocytopenia occurred in 47.5 and 32.5 % of patients, respectively. Treatment-related mortality was 15.0 % (n = 6), and four patients developed delayed neurotoxicity. There was no evidence of EBV-encoded RNA expression in brain tumor tissue. Ten (29.4 %) of 34 patients showed detectable EBV-DNA in whole blood. Poor performance status and EBV-DNA positivity in whole blood were significantly associated with inferior OS (p = 0.032, p = 0.023, respectively). We suggest that high-dose MVP chemotherapy followed by an early response-adapted intensification strategy may be effective and minimize the number of patients who receive radiotherapy or ASCT in the early course of treatment.

0 (DNA, Viral)
0 (RNA, Viral)
35S93Y190K (Procarbazine)
5J49Q6B70F (Vincristine)
YL5FZ2Y5U1 (Methotrexate)

Date Created: 20130802 Date Completed: 20140317 Latest Revision: 20151119

20221213

10.1007/s00277-013-1853-7

23903866