Abstract Details

PCNSL is a rare central nervous system malignancy, and long-term follow up studies are uncommon. First line therapy is based on high-dose methotrexate and consolidation therapy options. This is a long-term follow up study of PCNSL patients enrolled in a prospective trial using R-MPV chemotherapy regimen followed by high dose chemotherapy and autologous stem cell rescue to determine long-term survival and cognitive effects.

To evaluate over 10 years of follow-up the durability of high-dose methotrexate-centered therapy followed by high-dose chemotherapy with autologous stem cell consolidation for primary CNS lymphoma (PCNSL).

From June 2005 to September 2011, 32 newly diagnosed immunocompetent PCNSL were enrolled. Patients received 5-7 doses of rituximab (500mg/m²), methotrexate (3.5gm/m²), procarbazine (100mg/m²), and vincristine (1.4mg/m²) (R-MVP). Consolidation therapy consisted of high dose chemotherapy (HDC) with thiotepa (250mg/m²), busulfan (3.2mg/kg), and cyclophosphamide (60mg/kg), followed by autologous stem cell rescue (ASCT) in those with partial or complete response to R-MVP. Long-term follow-up status including disease status, functional status (KPS, NANO), and leukoencephalopathy (modified Fazkas) were collected.

26 of 32 underwent HDC and ACST. Of those, 3 died due to treatment related effects; 2 died of disease progression within two years after ASCT. After a median follow-up of 10.5 years, none of the remaining 21 patients progressed. At the time of last follow up, the median KPS was 90, compared to 80 at time of ASCT. The median NANO score and leukoencephalopathy score post ASCT and at follow-up did not change. Of note, 2 of 4 patients with a partial or complete response to R-MVP that elected not to proceed with HDC-ASCT consolidation, experienced progression at a mean of 52 months.

Long-term follow up demonstrates that treatment was tolerated well with stable leukoencephalopathy on MRI and good performance status. Disease recurrence 2 years after HDC with ASCT consolidation was not observed.