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

Lauren E. Abrey, Craig Moskowitz, Warren P. Mason, Michael Crump, Douglas Stewart, Peter Forsyth, Nina Paleologos, Denise D. Correa, Nicole D. Anderson, Dawn Caron, Andrew Zelenetz, Stephen D Nimer, Lisa M. DeAngelis

Research output: Contribution to journalArticle

217 Citations (Scopus)

Abstract

Purpose: To assess the safety and efficacy of intensive methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma (PCNSL). Patients and Methods: Twenty-eight patients received induction chemotherapy using high-dose systemic methotrexate (3.5 g/m2) and cytarabine (3 g/m 2 daily for 2 days). Fourteen patients with chemosensitive disease evident on neuroimaging then received high-dose therapy using carmustine, etoposide, cytarabine, and melphalan with autologous stem-cell rescue. Results: The objective response rate to the induction-phase chemotherapy was 57%, and median overall survival is not yet assessable, with a median follow-up time of 28 months. The overall median event-free survival time is 5.6 months for all patients and 9.3 months for 14 patients who underwent transplantation. Six of these 14 patients (43%) remained disease-free at last follow-up. Treatment was well tolerated; there was one transplantation-related death. Prospective neuropsychologic evaluations have revealed no evidence of treatment-related neurotoxicity. Conclusion: This treatment approach is feasible in patients with newly diagnosed PCNSL without evidence of significant related neurotoxicity. Although the transplantation results are similar to those achieved in patients with aggressive or poor-prognosis systemic lymphoma, the low response rate to induction chemotherapy and the significant number of patients who experienced relapse soon after HDT suggest that more aggressive induction chemotherapy may be warranted.

Original languageEnglish
Pages (from-to)4151-4156
Number of pages6
JournalJournal of Clinical Oncology
Volume21
Issue number22
DOIs
StatePublished - Nov 15 2003
Externally publishedYes

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Cytarabine
Methotrexate
Lymphoma
Stem Cells
Drug Therapy
Induction Chemotherapy
Transplantation
Carmustine
Melphalan
Etoposide
Therapeutics
Neuroimaging
Disease-Free Survival
Safety
Recurrence
Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

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. / Abrey, Lauren E.; Moskowitz, Craig; Mason, Warren P.; Crump, Michael; Stewart, Douglas; Forsyth, Peter; Paleologos, Nina; Correa, Denise D.; Anderson, Nicole D.; Caron, Dawn; Zelenetz, Andrew; Nimer, Stephen D; DeAngelis, Lisa M.

In: Journal of Clinical Oncology, Vol. 21, No. 22, 15.11.2003, p. 4151-4156.

Research output: Contribution to journalArticle

Abrey, Lauren E. ; Moskowitz, Craig ; Mason, Warren P. ; Crump, Michael ; Stewart, Douglas ; Forsyth, Peter ; Paleologos, Nina ; Correa, Denise D. ; Anderson, Nicole D. ; Caron, Dawn ; Zelenetz, Andrew ; Nimer, Stephen D ; DeAngelis, Lisa M. / 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. In: Journal of Clinical Oncology. 2003 ; Vol. 21, No. 22. pp. 4151-4156.
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abstract = "Purpose: To assess the safety and efficacy of intensive methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma (PCNSL). Patients and Methods: Twenty-eight patients received induction chemotherapy using high-dose systemic methotrexate (3.5 g/m2) and cytarabine (3 g/m 2 daily for 2 days). Fourteen patients with chemosensitive disease evident on neuroimaging then received high-dose therapy using carmustine, etoposide, cytarabine, and melphalan with autologous stem-cell rescue. Results: The objective response rate to the induction-phase chemotherapy was 57{\%}, and median overall survival is not yet assessable, with a median follow-up time of 28 months. The overall median event-free survival time is 5.6 months for all patients and 9.3 months for 14 patients who underwent transplantation. Six of these 14 patients (43{\%}) remained disease-free at last follow-up. Treatment was well tolerated; there was one transplantation-related death. Prospective neuropsychologic evaluations have revealed no evidence of treatment-related neurotoxicity. Conclusion: This treatment approach is feasible in patients with newly diagnosed PCNSL without evidence of significant related neurotoxicity. Although the transplantation results are similar to those achieved in patients with aggressive or poor-prognosis systemic lymphoma, the low response rate to induction chemotherapy and the significant number of patients who experienced relapse soon after HDT suggest that more aggressive induction chemotherapy may be warranted.",
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T1 - Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma

T2 - An intent-to-treat analysis

AU - Abrey, Lauren E.

AU - Moskowitz, Craig

AU - Mason, Warren P.

AU - Crump, Michael

AU - Stewart, Douglas

AU - Forsyth, Peter

AU - Paleologos, Nina

AU - Correa, Denise D.

AU - Anderson, Nicole D.

AU - Caron, Dawn

AU - Zelenetz, Andrew

AU - Nimer, Stephen D

AU - DeAngelis, Lisa M.

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N2 - Purpose: To assess the safety and efficacy of intensive methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma (PCNSL). Patients and Methods: Twenty-eight patients received induction chemotherapy using high-dose systemic methotrexate (3.5 g/m2) and cytarabine (3 g/m 2 daily for 2 days). Fourteen patients with chemosensitive disease evident on neuroimaging then received high-dose therapy using carmustine, etoposide, cytarabine, and melphalan with autologous stem-cell rescue. Results: The objective response rate to the induction-phase chemotherapy was 57%, and median overall survival is not yet assessable, with a median follow-up time of 28 months. The overall median event-free survival time is 5.6 months for all patients and 9.3 months for 14 patients who underwent transplantation. Six of these 14 patients (43%) remained disease-free at last follow-up. Treatment was well tolerated; there was one transplantation-related death. Prospective neuropsychologic evaluations have revealed no evidence of treatment-related neurotoxicity. Conclusion: This treatment approach is feasible in patients with newly diagnosed PCNSL without evidence of significant related neurotoxicity. Although the transplantation results are similar to those achieved in patients with aggressive or poor-prognosis systemic lymphoma, the low response rate to induction chemotherapy and the significant number of patients who experienced relapse soon after HDT suggest that more aggressive induction chemotherapy may be warranted.

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