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Early relapses in primary CNS lymphoma after response to polychemotherapy without intraventricular treatment: results of a phase II study

  • Clinical study - patient study
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Abstract

Background A systemic and intraventricular polychemotherapy regimen (the Bonn protocol) without radiotherapy resulted in durable responses in 75% of patients <60 years with primary CNS lymphoma (PCNSL), but was complicated by a high rate of Ommaya reservoir infections. Here, the efficacy and toxicity of this regimen without intraventricular treatment was evaluated in PCNSL. Patients and methods From August 2003 to November 2005, 18 patients with PCNSL <60 years (median age, 53 years) were treated in a phase II trial with a high-dose methotrexate (MTX; cycles 1, 2, 4 and 5) and cytarabine (Ara-C; cycles 3 and 6) based systemic therapy including dexamethasone, vinca-alkaloids, ifosfamide and cyclophosphamide. Results Study accrual was prematurely stopped in November 2005 due to a high rate of early relapses. Seventeen of 18 patients were assessable for response: nine (53%) achieved complete response (CR), two (12%) complete response/unconfirmed (CRu) and two (12%) partial response (PR); four (24%) showed progressive disease (PD). One treatment was stopped due to toxicity. Median follow-up was 23 months, median response duration was only 10 months in responding patients, and median time to treatment failure (TTF) was 8 months in the whole group. Median overall survival (OS) has not been reached. Systemic toxicity was mainly hematologic. Conclusions In PCNSL patients <60 years, polychemotherapy without intraventricular treatment results in a high response rate, but is associated with early relapses in the majority of cases. This is in contrast to the results achieved with the same protocol but with intraventricular treatment.

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Author notes

  1. Carlo Schaller

    Present address: Neurochirurgie, Hopitaux Universitaire de Genève, Suisse, Switzerland

Authors and Affiliations

  1. Department of Neurology, Knappschaftskrankenhaus, University of Bochum, In der Schornau, 23-25, 44892, Bochum, Germany

    Hendrik Pels, Annika Juergens & Uwe Schlegel

  2. Department of Internal Medicine, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany

    Axel Glasmacher & Ingo G. H. Schmidt-Wolf

  3. Department of Internal Medicine, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany

    Holger Schulz & Andreas Engert

  4. Department of Neurology, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland

    Michael Linnebank

  5. Department of Neurosurgery, University of Dresden, Fetscherstraße 74, 01397, Dresden, Germany

    Gabriele Schackert

  6. Department of Neurology, University of Dresden, Fetscherstraße 74, 01397, Dresden, German

    Heinz Reichmann

  7. Department of Internal Medicine, University of Dresden, Fetscherstraße 74, 01397, Dresden, Germany

    Frank Kroschinsky

  8. Department of Neurology, University of Heidelberg, Im Neuenheimerfeld 400, 69120, Heidelberg, Germany

    Marlies Vogt-Schaden

  9. Department of Internal Medicine, University of Kiel, Chemnitzstraße 33, 24116, Kiel, Germany

    Gerlinde Egerer

  10. Department of Pediatric Hemato-Oncology, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany

    Udo Bode

  11. Department of Neurosurgery, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany

    Carlo Schaller

  12. Department of Internal Medicine, University of Kiel, Chemnitzstraße 33, 24116, Kiel, Germany

    Monika Lamprecht

  13. Department of Neurology, University of Regensburg, Universitätsstraße 84, 93053, Regensburg, Germany

    Peter Hau

  14. Department of Neuropathology, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany

    Martina Deckert

  15. Institute of Biostatistics, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany

    Rolf Fimmers

  16. Department of Radiology, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany

    Christopher Bangard

Authors
  1. Hendrik Pels
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  2. Annika Juergens
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  3. Axel Glasmacher
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  4. Holger Schulz
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  5. Andreas Engert
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  6. Michael Linnebank
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  10. Marlies Vogt-Schaden
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  18. Christopher Bangard
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  19. Ingo G. H. Schmidt-Wolf
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  20. Uwe Schlegel
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Corresponding author

Correspondence to Uwe Schlegel.

Additional information

H. Pels and A. Juergens contributed equally.

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Pels, H., Juergens, A., Glasmacher, A. et al. Early relapses in primary CNS lymphoma after response to polychemotherapy without intraventricular treatment: results of a phase II study. J Neurooncol 91, 299–305 (2009). https://doi.org/10.1007/s11060-008-9712-4

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  • DOI: https://doi.org/10.1007/s11060-008-9712-4

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