Efficacy and safety of first-line high-dose cytarabine in patients with primary CNS lymphoma ineligible for high-dose methotrexate: A case series.

IF 2.4 Q2 CLINICAL NEUROLOGY

Neuro-oncology practice Pub Date : 2024-11-02 eCollection Date: 2025-02-01 DOI:10.1093/nop/npae109

Vanja Zeremski, Tobias Ronny Haage, Dimitrios Mougiakakos

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引用次数: 0

Abstract

Background: Despite recent significant advances, the treatment of elderly patients with primary central nervous system lymphoma (PCNSL) is still challenging due to comorbidities, poor baseline performance status (PS), and drug toxicities. There are proposals to use high-dose cytarabine (HD-araC) in these patients.

Methods: Our retrospective study aimed to assess the efficacy and toxicity of HD-araC as an upfront treatment for patients with PCNSL who are ineligible for high-dose methotrexate (HD-MTX).

Results: We identified 12 consecutive patients with newly diagnosed PCNSL (out of a total of 68) who received first-line treatment with HD-araC, with or without rituximab (R). Most of them had poor PS and relevant comorbidities. Six patients received this treatment upfront, while the other six received it after discontinuing HD-MTX-(based) therapy. Treatment with HD-araC resulted in poor outcome, limited response, and severe hematological and infectious complications. Patients who had previously received at least one cycle of HD-MTX appeared to have slightly better outcomes, highlighting the importance of HD-MTX in the treatment of PCNSL.

Conclusion: Our case series showed limited efficacy and substantial toxicity of (R)-HD-araC in patients with PCNSL ineligible for HD-MTX. This treatment should be omitted in elderly/frail patients to avoid further compromising their quality of life.

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一线高剂量阿糖胞苷治疗不适合大剂量甲氨蝶呤的原发性中枢神经系统淋巴瘤患者的疗效和安全性：一个病例系列。

背景：尽管近年来取得了重大进展，但由于合并症、不良的基线表现状态（PS）和药物毒性，老年原发性中枢神经系统淋巴瘤（PCNSL）的治疗仍然具有挑战性。建议在这些患者中使用高剂量阿糖胞苷（HD-araC）。方法：我们的回顾性研究旨在评估HD-araC作为不适合高剂量甲氨蝶呤（HD-MTX）的PCNSL患者的前期治疗的疗效和毒性。结果：我们确定了12例连续的新诊断的PCNSL患者（共68例），他们接受了HD-araC的一线治疗，有或没有利妥昔单抗(R)。他们大多数有不良的PS和相关的合并症。6名患者接受了这种治疗，而其他6名患者在停止HD-MTX（基于）治疗后接受了这种治疗。HD-araC治疗结果不佳，反应有限，并出现严重的血液学和感染并发症。先前接受过至少一个周期HD-MTX的患者似乎有稍好的结果，突出了HD-MTX在PCNSL治疗中的重要性。结论：我们的病例系列显示(R)-HD-araC对不适合HD-MTX治疗的PCNSL患者的疗效有限，毒性很大。老年人/体弱患者不应使用这种治疗，以避免进一步损害他们的生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuro-oncology practice CLINICAL NEUROLOGY-

CiteScore

5.30

自引率

11.10%

发文量

期刊介绍： Neuro-Oncology Practice focuses on the clinical aspects of the subspecialty for practicing clinicians and healthcare specialists from a variety of disciplines including physicians, nurses, physical/occupational therapists, neuropsychologists, and palliative care specialists, who have focused their careers on clinical patient care and who want to apply the latest treatment advances to their practice. These include: Applying new trial results to improve standards of patient care Translating scientific advances such as tumor molecular profiling and advanced imaging into clinical treatment decision making and personalized brain tumor therapies Raising awareness of basic, translational and clinical research in areas of symptom management, survivorship, neurocognitive function, end of life issues and caregiving