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Abstract：
BACKGROUND: A consolidation strategy has not been established for transplant-ineligible elderly patients with primary central nervous system lymphoma (PCNSL). In this study, we aimed to retrospectively evaluate the clinical outcomes of etoposide and cytarabine (EA) as consolidation chemotherapy for transplant-ineligible patients with PCNSL following high-dose methotrexate (MTX)-based induction chemotherapy.
METHODS: Between 2015 and 2021, newly diagnosed transplant-ineligible patients with PCNSL with diffuse large B-cell lymphoma were consecutively enrolled. All enrolled patients were over 60 years old and received EA consolidation after achieving a complete or partial response following induction chemotherapy.
RESULTS: Of the 85 patients who achieved a complete or partial response to MTX-based induction chemotherapy, 51 received EA consolidation chemotherapy. Among the 25 (49.0%, 25/51) patients in partial remission before EA consolidation, 56% (n = 14) achieved complete remission after EA consolidation. The median overall survival and progression-free survival were 43 and 13 months, respectively. Hematological toxicities were most common, and all patients experienced grade 4 neutropenia and thrombocytopenia. Forty-eight patients experienced febrile neutropenia during consolidation chemotherapy, and 4 patients died owing to treatment-related complications.
CONCLUSIONS: EA consolidation chemotherapy for transplant-ineligible, elderly patients with PCNSL improved response rates but showed a high relapse rate and short progression-free survival. The incidences of treatment-related mortality caused by hematologic toxicities and severe infections were very high, even after dose modification. Therefore, the use of EA consolidation should be reconsidered in elderly patients with PCNSL.
METHODS: Between 2015 and 2021, newly diagnosed transplant-ineligible patients with PCNSL with diffuse large B-cell lymphoma were consecutively enrolled. All enrolled patients were over 60 years old and received EA consolidation after achieving a complete or partial response following induction chemotherapy.
RESULTS: Of the 85 patients who achieved a complete or partial response to MTX-based induction chemotherapy, 51 received EA consolidation chemotherapy. Among the 25 (49.0%, 25/51) patients in partial remission before EA consolidation, 56% (n = 14) achieved complete remission after EA consolidation. The median overall survival and progression-free survival were 43 and 13 months, respectively. Hematological toxicities were most common, and all patients experienced grade 4 neutropenia and thrombocytopenia. Forty-eight patients experienced febrile neutropenia during consolidation chemotherapy, and 4 patients died owing to treatment-related complications.
CONCLUSIONS: EA consolidation chemotherapy for transplant-ineligible, elderly patients with PCNSL improved response rates but showed a high relapse rate and short progression-free survival. The incidences of treatment-related mortality caused by hematologic toxicities and severe infections were very high, even after dose modification. Therefore, the use of EA consolidation should be reconsidered in elderly patients with PCNSL.
摘要：
背景：对于移植不合格的原发性中枢神经系统淋巴瘤（PCNSL）老年患者，尚未建立巩固策略。在这项研究中,我们的目的是回顾性评估依托泊苷和阿糖胞苷(EA)作为不符合移植条件的PCNSL患者在大剂量甲氨蝶呤(MTX)基础诱导化疗后的巩固化疗的临床结局.
方法：在2015年至2021年之间，连续纳入新诊断的移植不合格的弥漫性大B细胞淋巴瘤PCNSL患者。所有入选患者均超过60岁，在诱导化疗后达到完全或部分反应后接受EA巩固。
结果：在对基于MTX的诱导化疗达到完全或部分反应的85例患者中，51例接受EA巩固化疗。在25人中(49.0%，25/51）EA巩固前部分缓解的患者，56%(n=14)在EA巩固后达到完全缓解。中位总生存期和无进展生存期分别为43个月和13个月。分别。血液毒性是最常见的，所有患者均出现4级中性粒细胞减少和血小板减少.48例患者在巩固化疗期间出现发热性中性粒细胞减少，4例患者因治疗相关并发症死亡。
结论：EA巩固化疗用于移植不合格，老年PCNSL患者缓解率提高,但复发率高,无进展生存期短.血液学毒性和严重感染引起的治疗相关死亡率非常高，即使在剂量修改后。因此,老年PCNSL患者应重新考虑使用EA巩固治疗.
方法：在2015年至2021年之间，连续纳入新诊断的移植不合格的弥漫性大B细胞淋巴瘤PCNSL患者。所有入选患者均超过60岁，在诱导化疗后达到完全或部分反应后接受EA巩固。
结果：在对基于MTX的诱导化疗达到完全或部分反应的85例患者中，51例接受EA巩固化疗。在25人中(49.0%，25/51）EA巩固前部分缓解的患者，56%(n=14)在EA巩固后达到完全缓解。中位总生存期和无进展生存期分别为43个月和13个月。分别。血液毒性是最常见的，所有患者均出现4级中性粒细胞减少和血小板减少.48例患者在巩固化疗期间出现发热性中性粒细胞减少，4例患者因治疗相关并发症死亡。
结论：EA巩固化疗用于移植不合格，老年PCNSL患者缓解率提高,但复发率高,无进展生存期短.血液学毒性和严重感染引起的治疗相关死亡率非常高，即使在剂量修改后。因此,老年PCNSL患者应重新考虑使用EA巩固治疗.
