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Article

Patients with Primary Central Nervous System Lymphoma Not Eligible for Clinical Trials: Prognostic Factors, Treatment and Outcome

1
Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, In der Schornau 23-25, D-44892 Bochum, Germany
2
Department of Hematology and Oncology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, In der Schornau 23-25, D-44892 Bochum, Germany
3
Department of Hematology and Oncology, Charité Berlin, University of Berlin, Hindenburgdamm 30, D-12203 Berlin, Germany
4
Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zürich, Switzerland
5
Department of Biostatistics and Clinical Epidemiology, University of Tübingen, Silcherstr. 5, D-72076 Tübingen, Germany
*
Author to whom correspondence should be addressed.
Academic Editor: Ryuya Yamanaka
Cancers 2021, 13(12), 2934; https://doi.org/10.3390/cancers13122934
Received: 2 June 2021 / Accepted: 8 June 2021 / Published: 11 June 2021
(This article belongs to the Special Issue Primary CNS Lymphomas: Diagnosis and Treatment)
Many patients with primary central nervous system lymphoma (PCNSL) participate in clinical trials. The inclusion criteria for these trials are largely uniform among various trials on first-line treatment. Therefore, there is a lack of data on therapeutic management and prognostic factors for patients not fulfilling these inclusion criteria. Here, we retrospectively analyzed treatment, outcome and prognostic factors of 34 patients of our center who did not fulfill inclusion criteria for clinical trials, and compared those results with data from the largest study of PCNSL patients, the G-PCNSL-SG-1 (German PCNSL Study Group 1) trial.
Patients with primary central nervous system lymphoma (PCNSL) not fulfilling inclusion criteria for clinical trials represent an underreported population. Thirty-four consecutive PCNSL patients seen at our center between 2005 and 2019 with exclusion criteria for therapeutic trials were analyzed (non-study patients) and compared with patients from the G-PCNSL-SG-1 (German PCNSL Study Group 1) study (study patients), the largest prospective multicenter trial on PCNSL, comprising 551 patients. Median follow up was 68 months (range 1–141) in non-study patients and 51 months (1–105) in study patients. Twenty-seven/34 (79.4%) non-study patients received high dose methotrexate (HDMTX), while seven/34 (20.6%) with a glomerular filtration rate (GFR) < 50 mL/min did not. Median overall survival (OS) was six months (95% confidence interval [CI] 0–21 months) in those 34 non-study patients. The 27 non-study patients treated with HDMTX were compared with 526/551 G-PCNSL-SG-1 study patients who had received HDMTX as well. Median OS was 20 months (95% CI 0–45)/21 months (95% CI 18–25) in 27 non-study/526 study patients (p = 0.766). Favorable prognostic factors in non-study patients were young age, application of HDMTX and early response on magnet resonance imaging (MRI). If HDMTX-based chemotherapy can be applied, long-term disease control is possible even in patients not qualifying for clinical trials. Initial response on early MRI might be useful for decision on treatment continuation. View Full-Text
Keywords: primary central nervous system lymphoma; polychemotherapy; high-dose methotrexate; cytarabine; Bonn protocol; non-study patients primary central nervous system lymphoma; polychemotherapy; high-dose methotrexate; cytarabine; Bonn protocol; non-study patients
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MDPI and ACS Style

Seidel, S.; Margold, M.; Kowalski, T.; Baraniskin, A.; Schroers, R.; Korfel, A.; Thiel, E.; Weller, M.; Martus, P.; Schlegel, U. Patients with Primary Central Nervous System Lymphoma Not Eligible for Clinical Trials: Prognostic Factors, Treatment and Outcome. Cancers 2021, 13, 2934. https://doi.org/10.3390/cancers13122934

AMA Style

Seidel S, Margold M, Kowalski T, Baraniskin A, Schroers R, Korfel A, Thiel E, Weller M, Martus P, Schlegel U. Patients with Primary Central Nervous System Lymphoma Not Eligible for Clinical Trials: Prognostic Factors, Treatment and Outcome. Cancers. 2021; 13(12):2934. https://doi.org/10.3390/cancers13122934

Chicago/Turabian Style

Seidel, Sabine, Michelle Margold, Thomas Kowalski, Alexander Baraniskin, Roland Schroers, Agnieszka Korfel, Eckhard Thiel, Michael Weller, Peter Martus, and Uwe Schlegel. 2021. "Patients with Primary Central Nervous System Lymphoma Not Eligible for Clinical Trials: Prognostic Factors, Treatment and Outcome" Cancers 13, no. 12: 2934. https://doi.org/10.3390/cancers13122934

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