Contributions
Abstract: PB1797
Type: Publication Only
Background
Central nervous system (CNS) lymphomas are aggressive entities which have a poor prognosis. Treatment has improved significantly after the high-dose methotrexate(HD-MTX)-based regimen used in recent years. The optimal treatment approach for patients with CNSL is still unclear, and there is no standard therapeutic approach for these patients.
Aims
The aim of this paper was to present the cases of 9 CNS lymphoma patients treated with the modified R-IDARAM protocol to shed some light on the effectiveness, tolerability and toxicity of this protocol.
Methods
A total of 9 patients, 7 with PCNL and 2 with SCNL, were treated with the modified R-IDARAM regimen,comprising rituximab 375 mg/m2 (day 1), idarubicin 10 mg/m2 (days 2 and 3), dexamethasone 100 mg/m2 (12-hr infusion on days 2, 3 and 4), cytosine arabinoside (ARA-C) 1 g/ m2 (1-hr infusion on days 2 and 3), methotrexate (MTX) (3 g/m2, 6-hr infusion on day 4) with folinic acid rescue, ARA-C 40 mg plus 15 mg MTX and dexamethasone 8 mg (via intrathecal route on days 1 and 8)The PCNSL patients were diagnosed from the examination of mass biopsy materials or surgically resected specimens. The Karnofsky Performance Status (KPS) scale was used to evaluate the performance status of patients. The risk profile and prognosis of patients were determined according to Memorial Sloan - Kettering Cancer Center (MSKCC) Prognostic Scoring system.Two additional courses of R-IDARAM (total four courses) were applied and all courses were given every 28 days.Complete remission (CR) referred to resolution of all apparent tumors. Partial Resolution (PR) of >50% of assessable disease, determined as the product of two diameters of measurable lesions, minor response/no change (MR/NC) was defined as a reduction of <50% of measurable disease but with no disease progression, and progressive disease (PD). The response was evaluated with cranial magnetic resonance imaging (MRI) for the PCNSL patients and additional thoraco-abdominal CT was performed for SCNSL.In patients where CR was achieved, follow-up was made every 3 months for 2 years and then every 6 months. The toxicity of the regimen was evaluated after all courses and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v4.0).
Results
CR was achieved in 4/7 PNCLS and 1 / 2 SCNCL patients after 2 courses. These PNCLS patients and 1 SCNCL patient are still being followed up without disease progression to date (66, 75 and 4 months, respectively).During the first course, 2 PCSNL patients died because of severe infection and 1 SCNSL patient died because of progressive CNS lymphoma with 1-month survival.All patients had grade 3-4 hematological side-effects including thrombocytopenia and neutropenia, and intravenous antibiotherapy was required during febrile episodes. Severe mucosal problems were experienced in 2 patients and grade 3 peripheral neuropathy in 1 patient. No cranial or neurological complications attributed to radiotherapy were detected.No cardiac or renal side-effects were seen in any patient.
Conclusion
The data of a small number of patients are presented here. Most patients achieved CR after induction therapy but this was not maintained for a long time. Few patients were able to complete the therapy completely due to poor performance status and social problems. Therefore, the long-term results are not satisfactory. More clinical trials are still needed to develop new therapeutic methods for CNSL. Nevertheless, it seems to be a good option with response rates, manageable toxicity and a well-tolerated regimen.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): chemotherapy, CNS lymphoma, Radiotherapy
Abstract: PB1797
Type: Publication Only
Background
Central nervous system (CNS) lymphomas are aggressive entities which have a poor prognosis. Treatment has improved significantly after the high-dose methotrexate(HD-MTX)-based regimen used in recent years. The optimal treatment approach for patients with CNSL is still unclear, and there is no standard therapeutic approach for these patients.
Aims
The aim of this paper was to present the cases of 9 CNS lymphoma patients treated with the modified R-IDARAM protocol to shed some light on the effectiveness, tolerability and toxicity of this protocol.
Methods
A total of 9 patients, 7 with PCNL and 2 with SCNL, were treated with the modified R-IDARAM regimen,comprising rituximab 375 mg/m2 (day 1), idarubicin 10 mg/m2 (days 2 and 3), dexamethasone 100 mg/m2 (12-hr infusion on days 2, 3 and 4), cytosine arabinoside (ARA-C) 1 g/ m2 (1-hr infusion on days 2 and 3), methotrexate (MTX) (3 g/m2, 6-hr infusion on day 4) with folinic acid rescue, ARA-C 40 mg plus 15 mg MTX and dexamethasone 8 mg (via intrathecal route on days 1 and 8)The PCNSL patients were diagnosed from the examination of mass biopsy materials or surgically resected specimens. The Karnofsky Performance Status (KPS) scale was used to evaluate the performance status of patients. The risk profile and prognosis of patients were determined according to Memorial Sloan - Kettering Cancer Center (MSKCC) Prognostic Scoring system.Two additional courses of R-IDARAM (total four courses) were applied and all courses were given every 28 days.Complete remission (CR) referred to resolution of all apparent tumors. Partial Resolution (PR) of >50% of assessable disease, determined as the product of two diameters of measurable lesions, minor response/no change (MR/NC) was defined as a reduction of <50% of measurable disease but with no disease progression, and progressive disease (PD). The response was evaluated with cranial magnetic resonance imaging (MRI) for the PCNSL patients and additional thoraco-abdominal CT was performed for SCNSL.In patients where CR was achieved, follow-up was made every 3 months for 2 years and then every 6 months. The toxicity of the regimen was evaluated after all courses and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v4.0).
Results
CR was achieved in 4/7 PNCLS and 1 / 2 SCNCL patients after 2 courses. These PNCLS patients and 1 SCNCL patient are still being followed up without disease progression to date (66, 75 and 4 months, respectively).During the first course, 2 PCSNL patients died because of severe infection and 1 SCNSL patient died because of progressive CNS lymphoma with 1-month survival.All patients had grade 3-4 hematological side-effects including thrombocytopenia and neutropenia, and intravenous antibiotherapy was required during febrile episodes. Severe mucosal problems were experienced in 2 patients and grade 3 peripheral neuropathy in 1 patient. No cranial or neurological complications attributed to radiotherapy were detected.No cardiac or renal side-effects were seen in any patient.
Conclusion
The data of a small number of patients are presented here. Most patients achieved CR after induction therapy but this was not maintained for a long time. Few patients were able to complete the therapy completely due to poor performance status and social problems. Therefore, the long-term results are not satisfactory. More clinical trials are still needed to develop new therapeutic methods for CNSL. Nevertheless, it seems to be a good option with response rates, manageable toxicity and a well-tolerated regimen.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): chemotherapy, CNS lymphoma, Radiotherapy