Improved survival outcomes despite older age at diagnosis: an era‐by‐era analysis of patients with primary central nervous system lymphoma treated at a single referral centre in the United Kingdom

Kaji, Furqaan A.; Martinez‐Calle, Nicolas; Bishton, Mark J.; Figueroa, Rocio; Adlington, Joanne; O’Donoghue, Michael; Smith, Stuart; Byrne, Paul; Paine, Simon; Sovani, Vishakha; Auer, Dorothee; James, Eleanor; Bessell, Eric M.; Grainge, Matthew J.; Fox, Christopher P.

Abstract

Observational studies with long-term follow-up of patients with primary central nervous system lymphoma (PCNSL) are scarce. Patient data over a period of four decades were retrospectively analysed from databases at Not-tingham University Hospitals Trust, UK. The cohort was delineated by two distinct therapeutic eras; the first from 01/01/1982 to 31/12/2010 (n = 147) and the second 01/01/2011 to 31/07/2020 (n = 125). The median age at diagnosis was significantly older in the second era compared to the first (69 and 65 years respectively, P = 0·003). The 3-, 6-and 12-month overall survival (OS) rates in the second era were significantly higher compared to the first, at 85%, 77%, 62% versus 56%, 49%, 38% respectively (log-rank test P < 0·0001). On multivariate analysis, high-dose methotrexate (HD-MTX)-based induction protocols employed in the second era were associated with improved OS compared to those used in the first [hazard ratio (HR) 0·40, 95% confidence interval (CI) 0·28–0·57]. Within the second era, superior OS rates were seen with the use of intensive HD-MTX protocols (including consolidation with high-dose chemotherapy and autologous stem cell transplantation) compared to non-intensive HD-MTX schedules (HR 0·47, 95% CI 0·22–0·99). Initiating chemotherapy within 14 days of biopsy and use of rituximab were independently associated with improved OS and progression-free survival during the second era. These data suggest that prompt treatment initiation and use of intensive HD-MTX-and rituximab-based protocols have resulted in improved survival outcomes for patients.

Citation

Kaji, F. A., Martinez‐Calle, N., Bishton, M. J., Figueroa, R., Adlington, J., O’Donoghue, M., Smith, S., Byrne, P., Paine, S., Sovani, V., Auer, D., James, E., Bessell, E. M., Grainge, M. J., & Fox, C. P. (2021). Improved survival outcomes despite older age at diagnosis: an era‐by‐era analysis of patients with primary central nervous system lymphoma treated at a single referral centre in the United Kingdom. British Journal of Haematology, 195(4), 561-570. https://doi.org/10.1111/bjh.17747

• Journal Article Type: Article
• Acceptance Date: Jul 19, 2021
• Online Publication Date: Aug 8, 2021
• Publication Date: Aug 8, 2021
• Deposit Date: Aug 17, 2021
• Publicly Available Date: Aug 9, 2022
• Journal: British Journal of Haematology
• Print ISSN: 0007-1048
• Electronic ISSN: 1365-2141
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 195
• Issue: 4
• Pages: 561-570
• DOI: https://doi.org/10.1111/bjh.17747
• Keywords: Hematology
• Public URL: https://nottingham-repository.worktribe.com/output/6055501
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/bjh.17747