Consolidation Improves Survival in Primary Central Nervous System Lymphoma without Preference for Type of High-Dose Methotrexate-Based Induction Treatment Regimen

Groot, Fleur A de; Doorduijn, Jeanette K.; Brink, Mirian; Groen, Ruben A.L. De; Haan, Lorraine M. de; Noordenbos, Troy; Sijs-Szabo, Aniko; Lam, King H.; Diepstra, Arjan; Boome, Liane te; Terpstra, Valeska; Böhmer, Lara H.; Zijlstra, Josée M.; Koens, Lianne; Durian, Marc; Oudshoorn, Mirjam A.; Veelken, Hendrik; Poel, Marjolein W. M. van der; Hamid, Myrurgia Abdul; Stevens, Wendy B C; Rooij, Josephus L. M. van; Oostvogels, Rimke; Neelis, Karen J.; Brand, Michiel van den; Woei-A-Jin, F J Sherida H; Tousseyn, Thomas; Dierickx, Daan; Jansen, Patty M.; Kersten, Marie José; Bromberg, Jacoline E C; Nijland, Marcel; Vermaat, Joost S.P.

doi:10.1182/blood-2022-163244

Cited by 4 publications

(3 citation statements)

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“…However, two real-world retrospective studies conducted in the United States and Australia reported no significant association between the intensity and type of high-dose methotrexate (HD-MTX) based induction regimens and PFS and OS. 15,16 Despite the lack of difference in PFS between the maintenance and observation groups, there was a slight increase in OS within the maintenance group (p = 0.091). The discrepancy in benefits between PFS and OS could be mainly attributed to the different recruitment periods.…”

Section: Discussionmentioning

confidence: 96%

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The role of upfront lenalidomide maintenance for primary central nervous system lymphoma following first‐line methotrexate treatment: A retrospective study

Zhang,

Wang,

Zhao

et al. 2024

Cancer Medicine

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BackgroundConsolidation therapy improves the duration of response among patients with primary central nervous system lymphoma (PCNSL). Lenalidomide maintenance has shown encouraging results in older patients with PCNSL. Herein, we performed a retrospective, single‐center analysis to evaluate the effect of lenalidomide maintenance on the duration of response in patients with newly‐diagnosed PCNSL.MethodsSixty‐nine adult patients with PCNSL who achieved complete remission or partial remission (PR) after induction therapy were enrolled. The median age of patients was 58.0 years. The maintenance group (n = 35) received oral lenalidomide (25 mg/day) for 21 days, every 28 days for 24 months; the observation group did not undergo any further treatment.ResultsAfter a median follow‐up of 32.6 months, the maintenance group experienced fewer relapse events. However, the median progression‐free survival (PFS) was similar between groups (36.1 vs. 30.6 months; hazard ratio, 0.78; 95% confidence interval, 0.446). Lenalidomide maintenance significantly improved PFS and overall survival (OS) only among patients who experienced PR after induction. The median duration of lenalidomide maintenance was 18 months; lenalidomide was well tolerated and minimally impacted the quality of life.ConclusionsThe present study was the first to evaluate lenalidomide maintenance as a frontline treatment among patients with PCNSL, PFS and OS did not improve, although the safety profile was satisfactory.

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Section: Discussionmentioning

confidence: 96%

“…These variations may have influenced the outcomes. However, two real‐world retrospective studies conducted in the United States and Australia reported no significant association between the intensity and type of high‐dose methotrexate (HD‐MTX) based induction regimens and PFS and OS 15,16 …”

Section: Discussionmentioning

confidence: 99%

The role of upfront lenalidomide maintenance for primary central nervous system lymphoma following first‐line methotrexate treatment: A retrospective study

Zhang,

Wang,

Zhao

et al. 2024

Cancer Medicine

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“…Real-world data from 885 evaluable patients undergoing MTXbased induction showed a 2-year OS of 51%. 8 Although efficacy of other regimens has been demonstrated in phase II trials, these are non-randomised trials without formal comparison thus one particular combination cannot be recommended 9 (MTX, rituximab (R), temozolomide 10 ; MTX, procarbazine, and vincristine 11 ; MTX, teniposide, carmustine and prednisolone 12 ), although familiarity with a regimen is prudent. In the patients randomised after induction, superior OS was observed in those proceeding to ASCT, compared to chemotherapy (3-year OS 86% vs. 71%, p = 0.0077), at a median follow up of 45 months.…”

Section: Inductionmentioning

confidence: 99%

Management of primary and secondary CNS lymphoma

Khwaja

Cwynarski

2023

Hematological Oncology

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Central nervous system (CNS) lymphoma has traditionally had very poor outcomes however advances in management have seen dramatic improvements and long‐term survival of patients. In primary CNS lymphoma there are now randomised trial data to inform practice, however secondary CNS lymphoma has a lack of randomised trial data and CNS prophylaxis remains a contentious area. We describe treatment strategies in these aggressive disorders. Dynamic assessment of patient fitness and frailty is key throughout treatment alongside delivery of CNS‐bioavailable therapy and enrolment in clinical trials. Intensive high‐dose methotrexate‐containing induction followed by autologous stem cell transplantation is preferred for patients who are fit. Less intensive chemoimmunotherapy, whole brain radiotherapy and novel therapies may be reserved for patients unfit or chemoresistant. It is essential to better define patients at increased risk of CNS relapse, as well as effective prophylactic strategies to prevent it. Future prospective studies incorporating novel agents are key.

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Comparison of Thiotepa-based Conditioning Regimens for Older Adults with Primary Diffuse Large B-cell Lymphoma of the Central Nervous System Undergoing Autologous Hematopoietic Cell Transplantation

Akhtar,

Arshad,

Lian

et al. 2024

Transplantation and Cellular Therapy

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Consolidation Improves Survival in Primary Central Nervous System Lymphoma without Preference for Type of High-Dose Methotrexate-Based Induction Treatment Regimen

Cited by 4 publications

References 0 publications

The role of upfront lenalidomide maintenance for primary central nervous system lymphoma following first‐line methotrexate treatment: A retrospective study

The role of upfront lenalidomide maintenance for primary central nervous system lymphoma following first‐line methotrexate treatment: A retrospective study

Management of primary and secondary CNS lymphoma

Comparison of Thiotepa-based Conditioning Regimens for Older Adults with Primary Diffuse Large B-cell Lymphoma of the Central Nervous System Undergoing Autologous Hematopoietic Cell Transplantation

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