Treatment of Patients with Relapsed or Refractory Primary CNS Lymphoma (rrPCNSL) Enrolled in the Randomized Trials of the International Extranodal Lymphoma Study Group (IELSG) in Blood
2021
AOU Città della Salute di Torino
Tipo pubblicazione
Conference Abstract
Autori/Collaboratori (21)Vedi tutti...
Ferreri AJM
Department of Translational and Precision Medicine, Division of Hematology, Rome, Italy
Cwynarski K
Department of Clinical Haematology, University College London Hospital, London, United Kingdom
Pulczynski E
Aarhus University Hospital, Aarhus, Denmark
et alii...
Abstract
Background. Literature on the treatment of rrPCNSL is limited to a few retrospective studies and phase II trials addressing new drugs or strategies. Evidence supporting therapeutic choice in patients (pts) with rrPCNSL after modern high-dose-methotrexate (HD-MTX)-based chemotherapy (chemo) followed by consolidative whole-brain irradiation (WBRT) or autologous stem cell transplantation (ASCT) is lacking. We reviewed management and outcome of pts with rrPCNSL in the randomized trials of the IELSG, which included 294 assessable pts, treated with modern approaches, and followed for several years. Herein, we analyse efficacy of salvage options to provide recommendations for routine practice. Methods. Pts enrolled in the IELSG20 or IELSG32 trials who experienced progressive disease (PD) at any time were considered. Pts who died due to toxicity and pts with extra-CNS relapse were excluded. Pts were grouped according to the time to progression after the first-line treatment: refractory (REF; relapse/PD ?6 months from end of treatment), early relapse (ER; 6-35 months) and late relapse (LR; ?36 months). Effect of salvage therapy on survival after relapse (SAR) was the primary objective. SAR was estimated from date of PD/relapse to date of death or last visit. Results. 164 pts (median age 58, range: 26-70; 94 males) were considered: 119 (73%) REF, 24 (15%) ER and 21 (13%) LR. First-line chemo included HD-MTX in all pts, alone in 31, +cytarabine in 68, +cytarabine/rituximab in 36, and +cytarabine/rituximab/thiotepa (MATRIX regimen) in 29. Consolidation was part of first-line treatment in 58 (35%) pts: WBRT in 39 and carmustine-thiotepa/conditioned ASCT in 19; 106 pts did not receive consolidation due to PD during first-line chemo (n=96), pt refusal (2), poor conditions (4) or per protocol (4). Treatment of relapsed/PD was WBRT in 47 pts and chemo in 58; 59 pts received only supportive care (BSC) due to rapid neurological impairment or pt refusal. Importantly, except
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DOI : 10.1182/blood-2021-147822
Keywords
carmustine; cytarabine; haloperidol; hydroxyzine; ifosfamide; methotrexate; new drug; rituximab; thiotepa; adult; advisory committee; aptitude; autologous stem cell transplantation; biomedicine; cancer combination chemotherapy; cancer patient; cancer recurrence; cancer resistance; cancer survival; chemotherapy; clinical trial; conference abstract; disease free interval; disease free survival; drug combination; drug megadose; drug therapy; ECOG Performance Status; employment; female; follow up; funding; gender; human; major clinical study; male; middle aged; mortality; nonhuman; patent; phase 2 clinical trial; primary central nervous system lymphoma; prospective study; randomized controlled trial; recurrent disease; relapse; remission; retreatment; retrospective study; rice; salvage therapy; thromboembolism; travel; whole brain radiotherapy;