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Combined modality therapy versus chemotherapy alone as an induction regimen for primary central nervous system lymphoma: a decision analysis
Author(s) -
Prica Anca,
Chan Kelvin,
Cheung Matthew C.
Publication year - 2012
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/j.1365-2141.2012.09208.x
Subject(s) - medicine , life expectancy , quality of life (healthcare) , chemotherapy , primary central nervous system lymphoma , regimen , oncology , quality adjusted life year , lymphoma , chemotherapy regimen , pediatrics , cost effectiveness , population , risk analysis (engineering) , nursing , environmental health
Summary In immunocompetent patients with primary central nervous system ( CNS ) lymphoma, combined modality therapy ( CMT ) using high‐dose methotrexate and whole brain radiotherapy has improved response rates compared to chemotherapy alone. The trade‐off is delayed and potentially devastating treatment‐related neurotoxicity. A M arkov decision‐analytic model compared CMT to chemotherapy alone in patients with primary CNS lymphoma. Baseline probabilities were derived from a systematic literature review. Outcomes were life expectancy and quality‐adjusted life expectancy. Sensitivity analyses were performed. The life expectancy was 2·69 years for CMT and 2·77 years for chemotherapy alone. The quality‐adjusted life expectancies for the two strategies were 1·70 and 1·67 quality‐adjusted life years ( QALY s) respectively. In younger patients <60 years of age, CMT yielded a quality‐adjusted life expectancy of 2·71 QALY s, compared to 2·09 QALY s for chemotherapy alone, yielding an expected benefit with CMT of 0·62 QALY s or 7·4 quality‐adjusted months. There was no difference between the strategies in the older group. The model was robust to key variables for the younger group. The preferred induction strategy for younger patients appears to be CMT , maximizing life expectancy, and QALY s. This analysis confirms that the preferred strategy for older patients is chemotherapy alone.