Management and outcome of primary CNS lymphoma in the modern era: An LOC network study

authors

  • Houillier Caroline
  • Soussain Carole
  • Ghesquières Hervé
  • Soubeyran Pierre
  • Chinot Olivier
  • Taillandier Luc
  • Lamy Thierry
  • Choquet Sylvain
  • Ahle Guido
  • Damaj Gandhi
  • Agapé Philippe
  • Moluçon-Chabrot Cécile
  • Amiel Alexandra
  • Delwail Vincent
  • Fabbro Michel
  • Jardin Fabrice
  • Chauchet Adrien
  • Moles-Moreau Marie-Pierre
  • Morschhauser Franck
  • Casasnovas Olivier
  • Gressin Rémy
  • Fornecker Luc-Matthieu
  • Abraham Julie
  • Marolleau Jean-Pierre
  • Tempescul Adrian
  • Campello Chantal
  • Colin Philippe
  • Tamburini Jérôme
  • Laribi Kamel
  • Serrier Caroline
  • Haioun Corinne
  • Chebrek Safia
  • Schmitt Anna
  • Blonski Marie
  • Houot Roch
  • Boyle Eileen
  • Bay Jacques-Olivier
  • Oberic Lucie
  • Tabouret Emeline
  • Waultier Agathe
  • Martin-Duverneuil Nadine
  • Touitou Valérie
  • Cassoux Nathalie
  • Kas Aurélie
  • Mokhtari Karima
  • Charlotte Frederic
  • Alentorn Agusti
  • Feuvret Loïc
  • Garff-Tavernier Magali Le
  • Costopoulos Myrto
  • Mathon Bertrand
  • Peyre Matthieu
  • Delgadillo Daniel
  • Douzane Hassen
  • Genet Diane
  • Aidaoui Bachir
  • Hoang-Xuan Khê
  • Gyan Emmanuel

document type

ART

abstract

Objective - Real-life studies on patients with primary CNS lymphoma (PCNSL) are scarce. Our objective was to analyze, in a nationwide population-based study, the current medical practice in the management of PCNSL. Methods - The French oculo-cerebral lymphoma network (LOC) database prospectively records all newly diagnosed PCNSL cases from 32 French centers. Data of patients diagnosed between 2011 and 2016 were retrospectively analyzed. Results - We identified 1,002 immunocompetent patients (43% aged >70 years, median Karnofsky Performance Status [KPS] 60). First-line treatment was high-dose methotrexate-based chemotherapy in 92% of cases, with an increasing use of rituximab over time (66%). Patients <60 years of age received consolidation treatment in 77% of cases, consisting of whole-brain radiotherapy (WBRT) (54%) or high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) (23%). Among patients >60 years of age, WBRT and HCT-ASCT consolidation were administered in only 9% and 2%, respectively. The complete response rate to initial chemotherapy was 50%. Median progression-free survival was 10.5 months. For relapse, second-line chemotherapy, HCT-ASCT, WBRT, and palliative care were offered to 55%, 17%, 10%, and 18% of patients, respectively. The median, 2-year, and 5-year overall survival was 25.3 months, 51%, and 38%, respectively (<60 years: not reached [NR], 70%, and 61%; >60 years: 15.4 months, 44%, and 28%). Age, KPS, sex, and response to induction CT were independent prognostic factors in multivariate analysis. Conclusions - Our study confirms the increasing proportion of elderly within the PCNSL population and shows comparable outcome in this population-based study with those reported by clinical trials, reflecting a notable application of recent PCNSL advances in treatment.

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