Advertisement
Journal of Clinical Oncology  
Search for:
Limit by:
  Browse by Subject or Issue
Home Search or Browse JCO My JCO Subscriptions Customer Service Site Map

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Save to my personal folders
Right arrow Download to citation manager
Right arrowRights & Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Abrey, L. E.
Right arrow Articles by DeAngelis, L. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Abrey, L. E.
Right arrow Articles by DeAngelis, L. M.
Journal of Clinical Oncology, Vol 18, Issue 17 (September), 2000: 3144-3150
© 2000 American Society for Clinical Oncology

Treatment for Primary CNS Lymphoma: The Next Step

By Lauren E. Abrey, Joachim Yahalom, Lisa M. DeAngelis

From the Departments of Neurology and Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.

Address reprint requests to Lauren E. Abrey, MD, Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; email abreyl{at}mskcc.org

PURPOSE: The use of preradiotherapy (RT) methotrexate (MTX) has improved disease control and survival in patients with primary CNS lymphoma (PCNSL). The reported protocol was designed to optimize and enhance the chemotherapeutic component of treatment.

PATIENTS AND METHODS: Fifty-two patients were treated with five cycles of high-dose MTX 3.5 g/m2, procarbazine 100 mg/m2/d, and vincristine 1.4 mg/m2. Thirty patients received whole-brain RT (45 Gy). Twenty-two older patients deferred RT to diminish the risk of delayed neurotoxicity; these patients are compared with 12 older patients who completed the entire treatment regimen. Most patients (n = 35) received high-dose cytarabine after RT.

RESULTS: Objective response rate to the induction chemotherapy regimen was 90%; overall median survival is 60 months. Grade 3 or 4 myelosuppression was seen in 30 patients, primarily in association with cytarabine; grade 3 nephrotoxicity due to MTX was seen in two patients. Older patients had similar median survival with or without the addition of RT: 32 versus 33 months, respectively. However, late neurotoxicity was significantly more common in those older patients who received RT (P = .00004). Patients younger than 60 years who received the complete treatment regimen have not reached median disease-free or overall survival.

CONCLUSION: Increasing the dose of MTX and adding procarbazine and vincristine improved disease control and overall survival in patients with newly diagnosed PCNSL. Younger patients in particular fared extremely well with this treatment regimen. In older patients, deferring whole-brain RT did not compromise overall survival but did reduce treatment-related toxicity.




This article has been cited by other articles:


Home page
 Ann OncolHome page
G. Illerhaus, R. Marks, F. Muller, G. Ihorst, F. Feuerhake, M. Deckert, C. Ostertag, and J. Finke
High-dose methotrexate combined with procarbazine and CCNU for primary CNS lymphoma in the elderly: results of a prospective pilot and phase II study
Ann. Onc., October 26, 2008; (2008) mdn628v1.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
S. A. Grimm, C. A. McCannel, A.M.P. Omuro, A. J.M. Ferreri, J. -Y. Blay, E. A. Neuwelt, T. Siegal, T. Batchelor, K. Jahnke, T. N. Shenkier, et al.
Primary CNS lymphoma with intraocular involvement: International PCNSL Collaborative Group Report
Neurology, October 21, 2008; 71(17): 1355 - 1360.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
F. M. Cady, B. P. O'Neill, M. E. Law, P. A. Decker, D. M. Kurtz, C. Giannini, A. B. Porter, P. J. Kurtin, P. B. Johnston, A. Dogan, et al.
Del(6)(q22) and BCL6 Rearrangements in Primary CNS Lymphoma Are Indicators of an Aggressive Clinical Course
J. Clin. Oncol., October 10, 2008; 26(29): 4814 - 4819.
[Abstract] [Full Text] [PDF]

Home page
 Neuro OncolHome page
Y. Shibamoto, H. Ogino, G. Suzuki, M. Takemoto, N. Araki, K. Isobe, E. Tsuchida, K. Nakamura, M. Kenjo, K. Suzuki, et al.
Primary central nervous system lymphoma in Japan: Changes in clinical features, treatment, and prognosis during 1985-2004
Neuro-oncol, August 1, 2008; 10(4): 560 - 568.
[Abstract] [Full Text] [PDF]

Home page
 Jpn J Clin OncolHome page
R. Yamanaka, K. Morii, Y. Shinbo, J. Homma, M. Sano, N. Tsuchiya, N. Yajima, T. Tamura, H. Hondoh, H. Takahashi, et al.
Results of Treatment of 112 Cases of Primary CNS Lymphoma
Jpn. J. Clin. Oncol., May 1, 2008; 38(5): 373 - 380.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
A. F. Hottinger, L. M. DeAngelis, J. Yahalom, and L. E. Abrey
Salvage whole brain radiotherapy for recurrent or refractory primary CNS lymphoma
Neurology, September 11, 2007; 69(11): 1178 - 1182.
[Abstract] [Full Text] [PDF]

Home page
 Ann OncolHome page
M Montemurro, T Kiefer, F Schuler, H. Al-Ali, H-H Wolf, R Herbst, A Haas, K Helke, A Theilig, C Lotze, et al.
Primary central nervous system lymphoma treated with high-dose methotrexate, high-dose busulfan/thiotepa, autologous stem-cell transplantation and response-adapted whole-brain radiotherapy: results of the multicenter Ostdeutsche Studiengruppe Hamato-Onkologie OSHO-53 phase II study
Ann. Onc., April 1, 2007; 18(4): 665 - 671.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
L. E. Abrey, L. Ben-Porat, K. S. Panageas, J. Yahalom, B. Berkey, W. Curran, C. Schultz, S. Leibel, D. Nelson, M. Mehta, et al.
Primary Central Nervous System Lymphoma: The Memorial Sloan-Kettering Cancer Center Prognostic Model
J. Clin. Oncol., December 20, 2006; 24(36): 5711 - 5715.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
I. T. Gavrilovic, A. Hormigo, J. Yahalom, L. M. DeAngelis, and L. E. Abrey
Long-Term Follow-Up of High-Dose Methotrexate-Based Therapy With and Without Whole Brain Irradiation for Newly Diagnosed Primary CNS Lymphoma
J. Clin. Oncol., October 1, 2006; 24(28): 4570 - 4574.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
G. Illerhaus, R. Marks, G. Ihorst, R. Guttenberger, C. Ostertag, G. Derigs, N. Frickhofen, F. Feuerhake, B. Volk, and J. Finke
High-Dose Chemotherapy With Autologous Stem-Cell Transplantation and Hyperfractionated Radiotherapy As First-Line Treatment of Primary CNS Lymphoma
J. Clin. Oncol., August 20, 2006; 24(24): 3865 - 3870.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Cancer Res.Home page
C.-H. Lin, K.-T. Kuo, S.-S. Chuang, S.-H. Kuo, J. H. Chang, K.-C. Chang, H.-C. Hsu, H.-F. Tien, and A.-L. Cheng
Comparison of the Expression and Prognostic Significance of Differentiation Markers between Diffuse Large B-Cell Lymphoma of Central Nervous System Origin and Peripheral Nodal Origin
Clin. Cancer Res., February 15, 2006; 12(4): 1152 - 1156.
[Abstract] [Full Text] [PDF]

Home page
 ASH Education BookHome page
L. M. DeAngelis and F. M. Iwamoto
An Update on Therapy of Primary Central Nervous System Lymphoma
Hematology, January 1, 2006; 2006(1): 311 - 316.
[Abstract] [Full Text] [PDF]

Home page
 Arch NeurolHome page
A. M. P. Omuro, L. S. Ben-Porat, K. S. Panageas, A. K. Kim, D. D. Correa, J. Yahalom, L. M. DeAngelis, and L. E. Abrey
Delayed Neurotoxicity in Primary Central Nervous System Lymphoma
Arch Neurol, October 1, 2005; 62(10): 1595 - 1600.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
L. E. Abrey, T. T. Batchelor, A. J.M. Ferreri, M. Gospodarowicz, E. J. Pulczynski, E. Zucca, J. R. Smith, A. Korfel, C. Soussain, L. M. DeAngelis, et al.
Report of an International Workshop to Standardize Baseline Evaluation and Response Criteria for Primary CNS Lymphoma
J. Clin. Oncol., August 1, 2005; 23(22): 5034 - 5043.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
K. Fliessbach, C. Helmstaedter, H. Urbach, A. Althaus, H. Pels, M. Linnebank, A. Juergens, A. Glasmacher, I. G. Schmidt-Wolf, T. Klockgether, et al.
Neuropsychological outcome after chemotherapy for primary CNS lymphoma: A prospective study
Neurology, April 12, 2005; 64(7): 1184 - 1188.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
T. N. Shenkier, J.-Y. Blay, B. P. O'Neill, P. Poortmans, E. Thiel, K. Jahnke, L. E. Abrey, E. Neuwelt, R. Tsang, T. Batchelor, et al.
Primary CNS Lymphoma of T-Cell Origin: A Descriptive Analysis From the International Primary CNS Lymphoma Collaborative Group
J. Clin. Oncol., April 1, 2005; 23(10): 2233 - 2239.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
P. L. Nguyen, A. Chakravarti, D. M. Finkelstein, F. H. Hochberg, T. T. Batchelor, and J. S. Loeffler
Results of Whole-Brain Radiation As Salvage of Methotrexate Failure for Immunocompetent Patients With Primary CNS Lymphoma
J. Clin. Oncol., March 1, 2005; 23(7): 1507 - 1513.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
A. M.P. Omuro, L. M. DeAngelis, J. Yahalom, and L. E. Abrey
Chemoradiotherapy for primary CNS lymphoma: An intent-to-treat analysis with complete follow-up
Neurology, January 11, 2005; 64(1): 69 - 74.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
R. H. Enting, A. Demopoulos, L. M. DeAngelis, and L. E. Abrey
Salvage therapy for primary CNS lymphoma with a combination of rituximab and temozolomide
Neurology, September 14, 2004; 63(5): 901 - 903.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Cancer Res.Home page
S. R. Plotkin, R. A. Betensky, F. H. Hochberg, S. A. Grossman, G. J. Lesser, L. B. Nabors, B. Chon, and T. T. Batchelor
Treatment of Relapsed Central Nervous System Lymphoma with High-Dose Methotrexate
Clin. Cancer Res., September 1, 2004; 10(17): 5643 - 5646.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
L. Fischer, E. Thiel, H. A. Klasen, H. Kirchen, K. Jahnke, and A. Korfel
Response of relapsed or refractory primary central nervous system lymphoma (PCNSL) to topotecan
Neurology, May 25, 2004; 62(10): 1885 - 1887.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
K. Hoang-Xuan and J.Y. Delattre
In Reply:
J. Clin. Oncol., March 15, 2004; 22(6): 1167 - 1168.
[Full Text] [PDF]

Home page
 JCOHome page
M. Reni and A. J.M. Ferreri
Is Withdrawal of Consolidation Radiotherapy an Evidence-Based Strategy in Primary Central Nervous System Lymphomas?
J. Clin. Oncol., March 15, 2004; 22(6): 1165 - 1167.
[Full Text] [PDF]

Home page
 NeurologyHome page
B. P. O'Neill
Neurocognitive outcomes in primary CNS lymphoma (PCNSL)
Neurology, February 24, 2004; 62(4): 532 - 533.
[Full Text] [PDF]

Home page
 NeurologyHome page
H. Harder, H. Holtel, J. E.C. Bromberg, P. Poortmans, H. Haaxma-Reiche, H. C. Kluin-Nelemans, J. Menten, and M. J. van den Bent
Cognitive status and quality of life after treatment for primary CNS lymphoma
Neurology, February 24, 2004; 62(4): 544 - 547.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
R. Lai, L. E. Abrey, M. K. Rosenblum, and L. M. DeAngelis
Treatment-induced leukoencephalopathy in primary CNS lymphoma: A clinical and autopsy study
Neurology, February 10, 2004; 62(3): 451 - 456.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
P. M.P. Poortmans, H. C. Kluin-Nelemans, H. Haaxma-Reiche, M. Van't Veer, M. Hansen, P. Soubeyran, M. Taphoorn, J. Thomas, M. Van den Bent, M. Fickers, et al.
High-Dose Methotrexate-Based Chemotherapy Followed by Consolidating Radiotherapy in Non-AIDS-Related Primary Central Nervous System Lymphoma: European Organization for Research and Treatment of Cancer Lymphoma Group Phase II Trial 20962
J. Clin. Oncol., December 15, 2003; 21(24): 4483 - 4488.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
H. Pels, I. G.H. Schmidt-Wolf, A. Glasmacher, H. Schulz, A. Engert, V. Diehl, A. Zellner, G. Schackert, H. Reichmann, F. Kroschinsky, et al.
Primary Central Nervous System Lymphoma: Results of a Pilot and Phase II Study of Systemic and Intraventricular Chemotherapy With Deferred Radiotherapy
J. Clin. Oncol., December 15, 2003; 21(24): 4489 - 4495.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
L. M. DeAngelis
Primary Central Nervous System Lymphoma: A Curable Brain Tumor
J. Clin. Oncol., December 15, 2003; 21(24): 4471 - 4473.
[Full Text] [PDF]

Home page
 JCOHome page
L. E. Abrey, C. H. Moskowitz, W. P. Mason, M. Crump, D. Stewart, P. Forsyth, N. Paleologos, D. D. Correa, N. D. Anderson, D. Caron, et al.
Intensive Methotrexate and Cytarabine Followed by High-Dose Chemotherapy With Autologous Stem-Cell Rescue in Patients With Newly Diagnosed Primary CNS Lymphoma: An Intent-to-Treat Analysis
J. Clin. Oncol., November 15, 2003; 21(22): 4151 - 4156.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
V. S. Lima, E. B. Leite, R. P. Fonseca, and A. S. Fernandes Jr
Patients Presenting With CNS Lesions: CASE 1. PRIMARY LOW-GRADE MUCOSA-ASSOCIATED B-CELL LYMPHOMA OF THE DURA
J. Clin. Oncol., November 1, 2003; 21(21): 4058 - 4060.
[Full Text] [PDF]

Home page
 Jpn J Clin OncolHome page
H. Ishikawa, M. Hasegawa, Y. Tamaki, K. Hayakawa, T. Akimoto, H. Sakurai, N. Mitsuhashi, H. Niibe, M. Tamura, and T. Nakano
Comparable Outcomes of Radiation Therapy without High-dose Methotrexate for Patients with Primary Central Nervous System Lymphoma
Jpn. J. Clin. Oncol., September 1, 2003; 33(9): 443 - 449.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
K. Hoang-Xuan, L. Taillandier, O. Chinot, P. Soubeyran, U. Bogdhan, J. Hildebrand, M. Frenay, N. De Beule, J.Y. Delattre, and B. Baron
Chemotherapy Alone as Initial Treatment for Primary CNS Lymphoma in Patients Older Than 60 Years: A Multicenter Phase II Study (26952) of the European Organization for Research and Treatment of Cancer Brain Tumor Group
J. Clin. Oncol., July 15, 2003; 21(14): 2726 - 2731.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
A. J.M. Ferreri, L. E. Abrey, J.-Y. Blay, B. Borisch, J. Hochman, E. A. Neuwelt, J. Yahalom, E. Zucca, F. Cavalli, J. Armitage, et al.
Summary Statement on Primary Central Nervous System Lymphomas From the Eighth International Conference on Malignant Lymphoma, Lugano, Switzerland, June 12 to 15, 2002
J. Clin. Oncol., June 15, 2003; 21(12): 2407 - 2414.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
T. Batchelor, K. Carson, A. O'Neill, S. A. Grossman, J. Alavi, P. New, F. Hochberg, and R. Priet
Treatment of Primary CNS Lymphoma With Methotrexate and Deferred Radiotherapy: A Report of NABTT 96-07
J. Clin. Oncol., March 15, 2003; 21(6): 1044 - 1049.
[Abstract] [Full Text] [PDF]

Home page
 Cancer Res.Home page
S. Roychowdhury, R. Peng, R. A. Baiocchi, D. Bhatt, S. Vourganti, J. Grecula, N. Gupta, C. F. Eisenbeis, G. J. Nuovo, W. Yang, et al.
Experimental Treatment of Epstein-Barr Virus-associated Primary Central Nervous System Lymphoma
Cancer Res., March 1, 2003; 63(5): 965 - 971.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
A. J.M. Ferreri, J.-Y. Blay, M. Reni, F. Pasini, M. Spina, A. Ambrosetti, A. Calderoni, A. Rossi, V. Vavassori, A. Conconi, et al.
Prognostic Scoring System for Primary CNS Lymphomas: The International Extranodal Lymphoma Study Group Experience
J. Clin. Oncol., January 15, 2003; 21(2): 266 - 272.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
H. A. Fine
Primary Central Nervous System Lymphoma: Time to Ask the Question
J. Clin. Oncol., December 15, 2002; 20(24): 4615 - 4617.
[Full Text] [PDF]

Home page
 JCOHome page
L. M. DeAngelis, W. Seiferheld, S. C. Schold, B. Fisher, and C. J. Schultz
Combination Chemotherapy and Radiotherapy for Primary Central Nervous System Lymphoma: Radiation Therapy Oncology Group Study 93-10
J. Clin. Oncol., December 15, 2002; 20(24): 4643 - 4648.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
R. Lai, M. K. Rosenblum, and L. M. DeAngelis
Primary CNS lymphoma: A whole-brain disease?
Neurology, November 26, 2002; 59(10): 1557 - 1562.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
A multicenter study of treatment of primary CNS lymphoma
Neurology, May 28, 2002; 58(10): 1513 - 1520.


Home page
 NeurologyHome page
B. Gleissner, J. Siehl, A. Korfel, R. Reinhardt, and E. Thiel
CSF evaluation in primary CNS lymphoma patients by PCR of the CDR III IgH genes
Neurology, February 12, 2002; 58(3): 390 - 396.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
E. M. Bessell, A. Lopez-Guillermo, S. Villa, E. Verger, B. Nomdedeu, J. Petit, P. Byrne, E. Montserrat, and F. Graus
Importance of Radiotherapy in the Outcome of Patients With Primary CNS Lymphoma: An Analysis of the CHOD/BVAM Regimen Followed by Two Different Radiotherapy Treatments
J. Clin. Oncol., January 1, 2002; 20(1): 231 - 236.
[Abstract] [Full Text] [PDF]

Home page
 ASH Education BookHome page
A. Lister, L. E. Abrey, and J. T. Sandlund
Central Nervous System Lymphoma
Hematology, January 1, 2002; 2002(1): 283 - 296.
[Abstract] [Full Text]

Home page
 NeurologyHome page
J. M. M. Gijtenbeek, M. K. Rosenblum, and L. M. DeAngelis
Primary central nervous system T-cell lymphoma
Neurology, August 28, 2001; 57(4): 716 - 718.
[Abstract] [Full Text] [PDF]

Home page
 NeurologyHome page
U. Buhring, U. Herrlinger, T. Krings, R. Thiex, M. Weller, and W. Kuker
MRI features of primary central nervous system lymphomas at presentation
Neurology, August 14, 2001; 57(3): 393 - 396.
[Abstract] [Full Text] [PDF]

Home page
 J. Neurol. Neurosurg. PsychiatryHome page
U Schlegel, H Pels, A Glasmacher, R Kleinschmidt, I Schmidt-Wolf, C Helmstaedter, K Fliessbach, M Deckert, D Van Roost, R Fimmers, et al.
Combined systemic and intraventricular chemotherapy in primary CNS lymphoma: a pilot study
J. Neurol. Neurosurg. Psychiatry, July 1, 2001; 71(1): 118 - 122.
[Abstract] [Full Text] [PDF]


About
JCO		 Editorial
Roster		 Advertising
Information		 Librarians &
Institutions		 Rights &
Permissions		 PDA Services

Copyright © 2000 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
Terms and Conditions of Use
  HighWire Press HighWire Press™ assists in the publication of JCO Online