Elderly Patients with Primary CNS Lymphoma Benefit from High-Dose Methotrexate Therapy

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Elderly patients with primary central nervous system lymphoma benefit from HD-MTX based therapy.
Elderly patients with primary central nervous system lymphoma benefit from HD-MTX based therapy.

According to a new study published in the journal Annals of Oncology, researchers have found that elderly patients with primary central nervous system lymphoma (PCNSL) benefit from high dose-methotrexate (HD-MTX) based therapy, especially when combined with oral alkylating agents.

For the review, investigators sought to investigate prognosis and effects of first-line therapy in elderly patients with PCNSL. They identified 20 studies that included data from 783 patients with a median age of 68 years and a median Karnofsky Performance Score of 60%. Researchers found that 73% of patients were treated with HD-MTX-based therapy and 35% received whole brain radiotherapy.

Results showed that a Karnofsky Performance Score ≥70% was the strongest prognostic factor for mortality (HR = 0.50; 95% CI: 0.41 - 0.62). Researchers found that after a median follow-up of 40 months, HD-MTX-based therapy was associated with improved survival (HR = 0.70; 95% CI: 0.53 - 0.93).

Researchers found no difference between more aggressive HD-MTX based therapies and HD-MTX plus oral chemotherapy (HR = 1.39; 95% CI: 0.90 - 2.15). In addition, despite being associated with improved survival, radiation therapy was linked with an elevated risk for neurological adverse events (OR = 5.23; 95% CI: 2.33 - 11.74).

The findings suggest that elderly patients with PCNSL benefit from HD-MTX-based therapy, particularly when used in combination with oral alkylating agents.

Reference

  1. Kasenda B, Ferreri AJM, Marturano E, et al. First-line treatment and outcome of elderly patients with primary central nervous system lymphoma (PCNSL) - a systematic review and individual patient data meta-analysis. Ann Oncol. 2015. [Epub ahead of print]. doi: 10.1093/annonc/mdv076

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