Abstract
Failure after first-line treatment was reported in 35–60% of immunocompetent patients with primary central nervous system lymphoma (PCNSL). There are currently no reports focusing on salvage therapy. This review analyses prognostic factors and the efficacy of salvage therapy by focusing on data from papers reporting results of first-line treatment in 355 cases. The study group consisted of 173 patients presenting treatment failure. The interval between failure and death (TTD) was compared for age at relapse (≤60 vs >60 years), type of failure (relapse vs progression), time to relapse (≤12 vs >12 months) and salvage treatment (yes vs no). Median TTD was similar in younger and older patients (P = 0.09). Relapsed patients had a longer TTD than patients with progressive disease (P = 0.002). Early relapse led to a shorter TTD than late relapse (P = 0.005). Median TTD was 14 months for patients who underwent salvage therapy and 2 months for untreated cases (P < 0.00001). A multivariate analysis showed an independent prognostic role for salvage therapy and time to relapse. Age and type of failure had no predictive value. Salvage therapy significantly improves outcome and, possibly, quality of life. As many different treatments were used conclusions cannot be made regarding an optimal treatment schedule. © 1999 Cancer Research Campaign
Keywords: primary central nervous system lymphoma, salvage treatment, brain neoplasms, extranodal lymphomas, non-Hodgkin's lymphoma
Full Text
The Full Text of this article is available as a PDF (74.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bessell E. M., Graus F., Punt J. A., Firth J. L., Hope D. T., Moloney A. J., Lopez-Guillermo A., Villa S. Primary non-Hodgkin's lymphoma of the CNS treated with BVAM or CHOD/BVAM chemotherapy before radiotherapy. J Clin Oncol. 1996 Mar;14(3):945–954. doi: 10.1200/JCO.1996.14.3.945. [DOI] [PubMed] [Google Scholar]
- Chamberlain M. C., Levin V. A. Adjuvant chemotherapy for primary lymphoma of the central nervous system. Arch Neurol. 1990 Oct;47(10):1113–1116. doi: 10.1001/archneur.1990.00530100081017. [DOI] [PubMed] [Google Scholar]
- DeAngelis L. M., Yahalom J., Thaler H. T., Kher U. Combined modality therapy for primary CNS lymphoma. J Clin Oncol. 1992 Apr;10(4):635–643. doi: 10.1200/JCO.1992.10.4.635. [DOI] [PubMed] [Google Scholar]
- Di Marco A., Rosta L., Campostrini F., Bonetti A., Palazzi M., Garusi G. The role of radiation therapy in the management of primary non-Hodgkin lymphomas of the central nervous system: clinical study of 10 cases. Tumori. 1986 Dec 31;72(6):565–573. doi: 10.1177/030089168607200605. [DOI] [PubMed] [Google Scholar]
- Ferreri A. J., Reni M., Bolognesi A., Verusio C., Villa E. Combined therapy for primary central nervous system lymphoma in immunocompetent patients. Eur J Cancer. 1995 Nov;31A(12):2008–2012. doi: 10.1016/0959-8049(95)00346-0. [DOI] [PubMed] [Google Scholar]
- Ferreri A. J., Reni M., Villa E. Primary central nervous system lymphoma in immunocompetent patients. Cancer Treat Rev. 1995 Sep;21(5):415–446. doi: 10.1016/0305-7372(95)90028-4. [DOI] [PubMed] [Google Scholar]
- Fine H. A., Mayer R. J. Primary central nervous system lymphoma. Ann Intern Med. 1993 Dec 1;119(11):1093–1104. doi: 10.7326/0003-4819-119-11-199312010-00007. [DOI] [PubMed] [Google Scholar]
- Freilich R. J., Delattre J. Y., Monjour A., DeAngelis L. M. Chemotherapy without radiation therapy as initial treatment for primary CNS lymphoma in older patients. Neurology. 1996 Feb;46(2):435–439. doi: 10.1212/wnl.46.2.435. [DOI] [PubMed] [Google Scholar]
- Glass J., Gruber M. L., Cher L., Hochberg F. H. Preirradiation methotrexate chemotherapy of primary central nervous system lymphoma: long-term outcome. J Neurosurg. 1994 Aug;81(2):188–195. doi: 10.3171/jns.1994.81.2.0188. [DOI] [PubMed] [Google Scholar]
- Glass J., Shustik C., Hochberg F. H., Cher L., Gruber M. L. Therapy of primary central nervous system lymphoma with pre-irradiation methotrexate, cyclophosphamide, doxorubicin, vincristine, and dexamethasone (MCHOD). J Neurooncol. 1996 Dec;30(3):257–265. doi: 10.1007/BF00177277. [DOI] [PubMed] [Google Scholar]
- Gonzalez D. G., Schuster-Uitterhoeve A. L. Primary non-Hodgkin's lymphoma of the central nervous system. Results of radiotherapy in 15 cases. Cancer. 1983 Jun 1;51(11):2048–2052. doi: 10.1002/1097-0142(19830601)51:11<2048::aid-cncr2820511115>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
- Kawakami Y., Tabuchi K., Ohnishi R., Asari S., Nishimoto A. Primary central nervous system lymphoma. J Neurosurg. 1985 Apr;62(4):522–527. doi: 10.3171/jns.1985.62.4.0522. [DOI] [PubMed] [Google Scholar]
- Krogh-Jensen M., d'Amore F., Jensen M. K., Christensen B. E., Thorling K., Pedersen M., Johansen P., Boesen A. M., Andersen E. Incidence, clinicopathological features and outcome of primary central nervous system lymphomas. Population-based data from a Danish lymphoma registry. Danish Lymphoma Study Group, LYFO. Ann Oncol. 1994 Apr;5(4):349–354. doi: 10.1093/oxfordjournals.annonc.a058839. [DOI] [PubMed] [Google Scholar]
- Lachance D. H., Brizel D. M., Gockerman J. P., Halperin E. C., Burger P. C., Boyko O. B., Brown M. T., Schold S. C., Jr Cyclophosphamide, doxorubicin, vincristine, and prednisone for primary central nervous system lymphoma: short-duration response and multifocal intracerebral recurrence preceding radiotherapy. Neurology. 1994 Sep;44(9):1721–1727. doi: 10.1212/wnl.44.9.1721. [DOI] [PubMed] [Google Scholar]
- Letendre L., Banks P. M., Reese D. F., Miller R. H., Scanlon P. W., Kiely J. M. Primary lymphoma of the central nervous system. Cancer. 1982 Mar 1;49(5):939–943. doi: 10.1002/1097-0142(19820301)49:5<939::aid-cncr2820490518>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
- Ling S. M., Roach M., 3rd, Larson D. A., Wara W. M. Radiotherapy of primary central nervous system lymphoma in patients with and without human immunodeficiency virus. Ten years of treatment experience at the University of California San Francisco. Cancer. 1994 May 15;73(10):2570–2582. doi: 10.1002/1097-0142(19940515)73:10<2570::aid-cncr2820731019>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
- Loeffler J. S., Ervin T. J., Mauch P., Skarin A., Weinstein H. J., Canellos G., Cassady J. R. Primary lymphomas of the central nervous system: patterns of failure and factors that influence survival. J Clin Oncol. 1985 Apr;3(4):490–494. doi: 10.1200/JCO.1985.3.4.490. [DOI] [PubMed] [Google Scholar]
- Mendenhall N. P., Thar T. L., Agee O. F., Harty-Golder B., Ballinger W. E., Jr, Million R. R. Primary lymphoma of the central nervous system. Computerized tomography scan characteristics and treatment results for 12 cases. Cancer. 1983 Dec 1;52(11):1993–2000. doi: 10.1002/1097-0142(19831201)52:11<1993::aid-cncr2820521104>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
- Murray K., Kun L., Cox J. Primary malignant lymphoma of the central nervous system. Results of treatment of 11 cases and review of the literature. J Neurosurg. 1986 Nov;65(5):600–607. doi: 10.3171/jns.1986.65.5.0600. [DOI] [PubMed] [Google Scholar]
- Neuwelt E. A., Goldman D. L., Dahlborg S. A., Crossen J., Ramsey F., Roman-Goldstein S., Braziel R., Dana B. Primary CNS lymphoma treated with osmotic blood-brain barrier disruption: prolonged survival and preservation of cognitive function. J Clin Oncol. 1991 Sep;9(9):1580–1590. doi: 10.1200/JCO.1991.9.9.1580. [DOI] [PubMed] [Google Scholar]
- O'Neill B. P., O'Fallon J. R., Earle J. D., Colgan J. P., Brown L. D., Krigel R. L. Primary central nervous system non-Hodgkin's lymphoma: survival advantages with combined initial therapy? Int J Radiat Oncol Biol Phys. 1995 Oct 15;33(3):663–673. doi: 10.1016/0360-3016(95)00207-F. [DOI] [PubMed] [Google Scholar]
- Peto R., Pike M. C. Conservatism of the approximation sigma (O-E)2-E in the logrank test for survival data or tumor incidence data. Biometrics. 1973 Sep;29(3):579–584. [PubMed] [Google Scholar]
- Pollack I. F., Lunsford L. D., Flickinger J. C., Dameshek H. L. Prognostic factors in the diagnosis and treatment of primary central nervous system lymphoma. Cancer. 1989 Mar 1;63(5):939–947. doi: 10.1002/1097-0142(19890301)63:5<939::aid-cncr2820630526>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
- Rampen F. H., van Andel J. G., Sizoo W., van Unnik J. A. Radiation therapy in primary non-Hodgkin's lymphomas of the CNS. Eur J Cancer. 1980 Feb;16(2):177–184. doi: 10.1016/0014-2964(80)90149-8. [DOI] [PubMed] [Google Scholar]
- Reni M., Ferreri A. J., Garancini M. P., Villa E. Therapeutic management of primary central nervous system lymphoma in immunocompetent patients: results of a critical review of the literature. Ann Oncol. 1997 Mar;8(3):227–234. doi: 10.1023/a:1008201717089. [DOI] [PubMed] [Google Scholar]
- Rodriguez M. A., Cabanillas F. C., Hagemeister F. B., McLaughlin P., Romaguera J. E., Swan F., Velasquez W. A phase II trial of mesna/ifosfamide, mitoxantrone and etoposide for refractory lymphomas. Ann Oncol. 1995 Jul;6(6):609–611. doi: 10.1093/oxfordjournals.annonc.a059252. [DOI] [PubMed] [Google Scholar]
- Sagerman R. H., Cassady J. R., Chang C. H. Radiation therapy for intracranial lymphoma. Radiology. 1967 Mar;88(3):552–554. doi: 10.1148/88.3.542. [DOI] [PubMed] [Google Scholar]
- Sarazin M., Ameri A., Monjour A., Nibio A., Poisson M., Delattre J. Y. Primary central nervous system lymphoma: treatment with chemotherapy and radiotherapy. Eur J Cancer. 1995 Nov;31A(12):2003–2007. doi: 10.1016/0959-8049(95)00345-2. [DOI] [PubMed] [Google Scholar]
- Schultz C., Scott C., Sherman W., Donahue B., Fields J., Murray K., Fisher B., Abrams R., Meis-Kindblom J. Preirradiation chemotherapy with cyclophosphamide, doxorubicin, vincristine, and dexamethasone for primary CNS lymphomas: initial report of radiation therapy oncology group protocol 88-06. J Clin Oncol. 1996 Feb;14(2):556–564. doi: 10.1200/JCO.1996.14.2.556. [DOI] [PubMed] [Google Scholar]
- Selch M. T., Shimizu K. T., De Salles A. F., Sutton C., Parker R. G. Primary central nervous system lymphoma. Results at the University of California at Los Angeles and review of the literature. Am J Clin Oncol. 1994 Aug;17(4):286–293. [PubMed] [Google Scholar]
- Shibamoto Y., Tsutsui K., Dodo Y., Yamabe H., Shima N., Abe M. Improved survival rate in primary intracranial lymphoma treated by high-dose radiation and systemic vincristine-doxorubicin-cyclophosphamide-prednisolone chemotherapy. Cancer. 1990 May 1;65(9):1907–1912. doi: 10.1002/1097-0142(19900501)65:9<1907::aid-cncr2820650906>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
- Socié G., Piprot-Chauffat C., Schlienger M., Legars D., Thurel C., Mikol J., Ifran N., Brière J., Pene F., Gindrey-Vie B. Primary lymphoma of the central nervous system. An unresolved therapeutic problem. Cancer. 1990 Jan 15;65(2):322–326. doi: 10.1002/1097-0142(19900115)65:2<322::aid-cncr2820650223>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
- Uematsu M., Kondo M., Dokiya T., Oguchi Y., Toya S., Torikata C., Kuribayashi T., Hashimoto S. Primary non-AIDS related brain lymphoma. Patterns of failure following radiotherapy. Acta Oncol. 1992;31(5):551–554. doi: 10.3109/02841869209088305. [DOI] [PubMed] [Google Scholar]
- Watne K., Scott H., Hager B., Lindegaard M. W., Nome O., Abrahamsen A. F., Hirschberg H. Primary malignant lymphoma of the brain. A report of 24 cases from the Norwegian Radium Hospital. Acta Oncol. 1992;31(5):545–550. doi: 10.3109/02841869209088304. [DOI] [PubMed] [Google Scholar]
- Woodman R., Shin K., Pineo G. Primary non-Hodgkin's lymphoma of the brain. A review. Medicine (Baltimore) 1985 Nov;64(6):425–430. doi: 10.1097/00005792-198511000-00006. [DOI] [PubMed] [Google Scholar]