Increasing use of immunotherapy and prolonged survival among younger patients with primary CNS lymphoma: a population-based study

Acta Oncol. 2019 Jul;58(7):967-976. doi: 10.1080/0284186X.2019.1599137. Epub 2019 Apr 17.

Abstract

Background: Primary CNS lymphoma is a highly aggressive and rare type of extranodal non-Hodgkin lymphoma. Although, new therapeutic approaches have led to improved survival, the management of the disease poses a challenge, practice patterns vary across institutions and countries, and remain ill-defined for vulnerable patient subgroups. Material and Methods: Using information from the Austrian Brain Tumor Registry we followed a population-based cohort of 189 patients newly diagnosed from 2005 to 2010 through various lines of treatment until death or last follow-up (12-31-2016). Prognostic factors and treatment-related data were integrated in a comprehensive survival analysis including conditional survival estimates. Results: We find variable patterns of first-line treatment with increasing use of rituximab and high-dose methotrexate (HDMTX)-based poly-chemotherapy after 2007, paralleled by an increase in median overall survival restricted to patients aged below 70 years. In the entire cohort, 5-year overall survival was 24.4% while 5-year conditional survival increased with every year postdiagnosis. Conclusion: In conclusion, we show that the use of poly-chemotherapy and immunotherapy has disseminated to community practice to a fair extent and survival has increased over time at least in younger patients. Annually increasing conditional survival rates provide clinicians with an adequate and encouraging prognostic measure.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Agents, Immunological / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Austria / epidemiology
  • Brain Neoplasms / drug therapy*
  • Brain Neoplasms / mortality
  • Female
  • Follow-Up Studies
  • Humans
  • Lymphoma, Non-Hodgkin / drug therapy*
  • Lymphoma, Non-Hodgkin / mortality
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • Prognosis
  • Progression-Free Survival
  • Registries / statistics & numerical data
  • Rituximab / therapeutic use
  • Survival Analysis
  • Young Adult

Substances

  • Antineoplastic Agents, Immunological
  • Rituximab
  • Methotrexate