PCV salvage chemotherapy for recurrent primary CNS lymphoma
[Show abstract] [Hide abstract] ABSTRACT: Background: Optimal treatment for recurrent primary central nervous system lymphomas (PCNSLs) has not been defined yet and there is no general consensus about the salvage chemotherapy after high-dose methotrexate (HD-MTX)-based chemotherapy. The purpose of the present study was to evaluate the efficacy and safety of procarbazine, lomustine, and vincristine (PCV) chemotherapy for recurrent PCNSLs. Methods: We reviewed eight immunocompetent patients (five males/three females, mean age: 56 years) who received salvage PCV chemotherapy (procarbazine 60 mg/m(2), days 8 through 21: CCNU 110 mg/m(2), day 1: vincristine 2 mg, days 8 and 28) for recurrent PCNSL and two patients switched to PCV chemotherapy due to severe adverse effects of HD-MTX chemotherapy. Radiologic responses, survival, and adverse effects were analyzed. Results: Of the eight recurrent PCNSLs, three patients (37.5%) showed radiologic complete response, one patient (12.5%) showed partial response, and four patients (50%) showed progressive disease after PCV chemotherapy. Median progression free survival (PFS) from the first administration of PCV to relapse or last follow-up was 7 months (range 5-32 months) and median overall survival was 8 months (range 2-41 months). The two patients who switched to PCV chemotherapy showed PFS of 9 and 5 months from the beginning of PCV to relapse. The common side effects were thrombocytopenia, neutropenia, and peripheral neuropathy. There were 4 grade III or IV myelo-suppression, but no fatal complications, including severe hemorrhage or infection, were observed. Conclusion: Salvage PCV chemotherapy has a moderate anti-lymphoma activity for recurrent PCNSLs after the HD-MTX-based chemotherapy with tolerable toxicity.0Comments 0Citations
- "It should also be emphasized that, since three patients received only one cycle (4 people within 2 cycles, 6 people within 3 cycles) at earlier stages, the patient selection is also an important factor . There was one preliminary report of salvage PCV chemotherapy for seven relapsed or refractory PCNSL patients with 86% response rate (CR: 57%, PR: 28%) and 16+ months OS . In this report, the authors suggested that there might be an overestimation of the response rate because of additional corticosteroid medication in two patients. "
[Show abstract] [Hide abstract] ABSTRACT: Opinion statement Therapeutic options are limited in primary central nervous system lymphoma (PCNSL) with no uniform consensus on optimal management and few published, randomized trials. High-dose methotrexate in combination with other chemotherapeutic agents forms the mainstay of treatment. There hasn’t been much progress beyond high-dose methotrexate in this disease, and although results from trials using high-dose chemotherapy and autologous stem-cell transplant seem promising, these need to be further validated. Moreover, the role of whole brain radiation in the upfront setting remains to be determined. However, international efforts in this direction are underway, with ongoing randomized trials in newly diagnosed PCNSL, more research on the molecular pathogenesis and biomarkers, and the use of novel agents in salvage therapy. There also is emphasis on quality of life parameters and neurocognitive status. Future treatment options should optimize high-efficacy rates while minimizing the risk of neurotoxicity.0Comments 3Citations
- "Topotecan also has been found to be useful in salvage treatment with response rates of 33-40 % and median OS of 8.4 and 35 months in two differ- 546 Neuro-oncology (GJ Lesser, Section Editor) ent studies [70, 71]. Other salvage treatments have included combination of etoposide, ifosfamide, and cytarabine, and procarbazine, lomustine, and vincristine with response rates of 37 % and 86 %, respectively, and 1-year OS of 41 % and 57 %, respectively [72, 73]. Rubenstein and Treseler successfully treated a patient with intraocular lymphoma with lenalidomide, an immunomodulating drug (IMiD) . "
[Show abstract] [Hide abstract] ABSTRACT: We previously reported the results of a phase II study for patients with newly diagnosed primary central nervous system lymphoma treated with autologous peripheral blood stem-cell transplantation (aPBSCT) and response-adapted whole-brain radiotherapy (WBRT). Now, we update the initial results. From 1999 to 2004, 23 patients received high-dose methotrexate. In case of at least partial remission, high-dose busulfan/thiotepa (HD-BuTT) followed by aPBSCT was carried out. Patients refractory to induction or without complete remission after HD-BuTT received WBRT. Eight patients still alive in 2011 were contacted and Mini-Mental State Examination (MMSE) and the European Organisation for Research and Treatment of Cancer quality-of-life questionnaire (QLQ)-C30 were carried out. Of eight patients still alive, median follow-up is 116.9 months. Only one of nine irradiated patients is still alive with a severe neurologic deficit. In seven of eight patients treated with HD-BuTT, health condition and quality of life are excellent. MMSE and QLQ-C30 showed remarkably good results in patients who did not receive WBRT. All of them have a Karnofsky score of 90%-100%. Follow-up shows an overall survival of 35%. In six of seven patients where WBRT could be avoided, no long-term neurotoxicity has been observed and all patients have an excellent quality of life.0Comments 16Citations
- "As described in other studies, late relapses are not uncommon [5, 8, 9]. We saw the latest relapse after >100 months, which underlines the importance of regular and longlasting follow-up, since a promising salvage therapy is available1011121314. One systemic relapse in the testis occurred and could be successfully managed with R-CHOP chemoimmunotherapy. "
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.