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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
Author(s) -
Kaji Furqaan A.,
MartinezCalle 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.
Publication year - 2021
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.17747
Subject(s) - medicine , hazard ratio , rituximab , primary central nervous system lymphoma , confidence interval , autologous stem cell transplantation , proportional hazards model , surgery , chemotherapy , lymphoma
Summary 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 Nottingham 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.