Low-Dose Lenalidomide Maintenance in Older Patients With PCNSL

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Given the high likelihood of comorbidities and poor performance status in older patients with PCNSL, alternative treatment approaches are needed for this population of patients.
Given the high likelihood of comorbidities and poor performance status in older patients with PCNSL, alternative treatment approaches are needed for this population of patients.

A retrospective analysis of a small cohort of older patients with primary central nervous system lymphoma (PCNSL) receiving low-dose lenalidomide maintenance following methotrexate/rituximab-based induction therapy revealed encouraging preliminary results regarding the safety and efficacy of this approach. This article was published online in the British Journal of Haematology. 1

Despite increasing evidence regarding the potential for cure in patients with PCNSL, the prognosis for older patients with this disease is generally poor. Although analyses performed using the Surveillance, Epidemiology and End Results (SEER) database showed progression-free survival (PFS) and overall survival (OS) gains over the past 40 years for younger patients with PCNSL, median OS in patients aged 70 years or older was observed to essentially remain unchanged (ie, 6-7 months) during this time period.2 Because high-dose chemotherapy is not an option for the majority of older patients with PCNSL, alternative treatment approaches are needed.

This study was a retrospective review of a small cohort of older patients with PCNSL treated at the University of California, San Francisco with low-dose lenalidomide after achieving a partial or complete response following methotrexate/rituximab-based induction therapy.

This analysis included the first 13 consecutive patients treated with this regimen, with the majority having received low-dose methotrexate during induction therapy.  Median age at diagnosis was 77 years, median Karnofsky score was 60, and median International Extranodal Lymphoma Study Group PCNSL prognostic risk score was 4 in this patient cohort.

At a median follow-up of 31.6 months, median time on lenalidomide maintenance was 18.9 months, with median PFS not yet reached. Lenalidomide maintenance was deemed well tolerated in older patients with PCNSL.

“We suggest that studies be conducted to prospectively test these hypotheses regarding the benefit of low-dose lenalidomide maintenance in older patients with PCNSL,” the study authors wrote in conclusion.

References

  1. Vu KMannis GHwang J, et al. Low- dose lenalidomide maintenance after induction therapy in older patients with primary central nervous system lymphoma [published online February 3, 2019]. Br J Haematol. doi: 10.1111/bjh.15787
  2. Mendez JSOstrom QTGittleman H, et al. The elderly left behind-changes in survival trends of primary central nervous system lymphoma over the past 4 decades. Neuro Oncol. 2018;20(5):687-694.

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