Rituximab, methotrexate, procarbazine and lomustine (R-MPL) for the treatment of primary Central nervous system lymphoma. Issue 9 (29th July 2022)

• Record Type: Journal Article
• Authors: Lebel, Eyal; Goldschmidt, Neta; Siegal, Tali; Lossos, Alexander; Rosenberg, Shai; Makranz, Chen; Linetski, Eduard; Gatt, Moshe E.; Gural, Alexander; Saban, Revital; Lavie, David; Vainstein, Vladimir; Zimran, Eran; Avni, Batia; Grisaro, Sigal; Shaulov, Adir; Nachmias, Boaz
• Is Part Of: Leukemia & lymphoma. Volume 63:Issue 9(2022)
• Page Start: 2102
• Page End: 2108
• Publication Date: 2022-07-29
• Subjects: Primary CNS lymphoma -- methotrexate -- procarbazine -- lomustine; Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.1080/10428194.2022.2064996
• Languages: English
• ISSNs: 1042-8194

Abstract

Abstract: The optimal high-dose methotrexate (HDMTX)-based combination therapy for primary central nervous system lymphoma is unknown. We report our experience with rituximab, HDMTX, procarbazine and lomustine (R-MPL) given as first-line treatment in our center. Fifty-two patients between 2006 and 2019 were included. Eighteen patients proceeded to autologous transplant or two cycles of intermediate-dose cytarabine. The median age was 62 y (range 28–94) and the Eastern Cooperative Oncology Group performance status (ECOG-PS) was ≥2 in 62% (32/52). The overall/complete response rates were 79% (41/52) and 52% (27/52), respectively. The median progression-free/overall survival was 19 m/84m, respectively. Grade 3–4 adverse events included infections (17%) and kidney injury (13%). Ten patients (19%) discontinued therapy for toxicity. There were no treatment-related deaths. In summary, in a cohort enriched in frail patients, R-MPL achieved good responses and OS and was safe for all ages. The PFS was sub-optimal, possibly explained by a low proportion of consolidation. This regimen should be evaluated prospectively.