Figure 8.

Long-term cognitive outcomes in patients treated with blood-brain barrier disruption (BBBD). Patients with newly diagnosed primary CNS lymphoma (PCNSL) were treated with intraarterial (IA) methotrexate-based chemotherapy with BBBD. The median time from diagnosis to long-term evaluation was 12 years (range: 2–26 years). (A) Raw cognitive test scores were converted to z-scores based on the normative values demographically adjusted to age. A z-score is the number of standard deviations above or below the mean for a population of similar age. A domain score was obtained by averaging all test z-scores in each domain, for each participant. The z-scores (mean, ±SD) across survivors at baseline (pretreatment), long-term follow-up, and the change score are shown. The asterisks indicate statistical significance. There was improvement in Trail-making A, P=0.0085; Trail-making B, P=0.0411; and attention/executive function domain, P< 0.001. (B) The z-scores (mean, ±SD) across the PCNSL survivors at baseline, long-term follow-up, and the change score for verbal memory, learning; verbal memory, delayed; and verbal memory domain are shown. There was no significant change from baseline to long-term follow-up. (C) Number of PCNSL patients declined (z-score declined one SD or more), stable (z-score remained within one SD of baseline score), and improved (z-score improved one SD or more) from baseline to long-term for the following tests: digit span forward, digit span backward, trail making a, trail making b, verbal memory learning, and verbal memory delayed. Reprinted with permission from Doolittle, Dosa, et al. (2013), © 2013 American Society of Clinical Oncology.