Clinical outcomes and treatment patterns of primary central nervous system lymphoma: Multicenter retrospective analysis

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dc.authorid0000-0001-6826-7818
dc.authorid0000-0001-9636-4113
dc.contributor.authorGüven, Serkan
dc.contributor.authorYavuz, Boran
dc.contributor.authorErdoğan Yücel, Elçin
dc.contributor.authorKarataş, Aylin Fatma
dc.contributor.authorÖzsan, Güner Hayri
dc.contributor.authorDemirkan, Fatih
dc.contributor.authorÜndar, Bülent
dc.contributor.authorÖzcan, Mehmet Ali
dc.contributor.authorKiper, Hatice Demet
dc.contributor.authorÇetintepe, Tuğba
dc.contributor.authorGöçer, Mesut
dc.contributor.authorKurtoğlu, Erdal
dc.contributor.authorBalık Aydın, Berrin
dc.contributor.authorSevindik, Ömür Gökmen
dc.contributor.authorYiğit Kaya, Süreyya
dc.contributor.authorAlacacıoğlu, İnci
dc.date.accessioned2023-03-28T07:33:30Z
dc.date.available2023-03-28T07:33:30Z
dc.date.issued2023
dc.departmentİstanbul Medipol Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, İç Hastalıkları Ana Bilim Dalı
dc.description.abstractObjectives: Primary central nervous system lymphoma (PCNSL) is a rare malignant disease with poor prognosis. Its low incidence leads to challenges in decision-making for treatment. As a matter of fact, there is still no consensus on the appropriate treatment modalities. In this context, the objective of this study is to investigate and comparatively assess the efficacies of several treatment modalities in the treatment of PCNSL. Methods: Thirty-four patients diagnosed with PCNSL at 5 different hematology centers between 2007 and 2021 were included in the study. Patients’ data from all five centers were collected retrospectively. Since ibrutinib is not approved for this indication in Turkey, consent for off-label use of ibrutinib is obtained from each patient. Ethics committee ap-proval was obtained on June 9, 2021 with decision number 2021/18-05. Results: The median age of the patients was 59 (min.: 22, max.: 78) years. The male-to-female ratio was 1.26/1. Nineteen (55.9%) patients had Eastern Cooperative Oncology Group (ECOG) performance score of ?2. Fifteen (44.1%) patients had normal lactate dehydrogenase (LDH) levels and only 14.7% of the patients had B symptoms at the time of diagnosis. Magnetic resonance imaging (MRI) revealed a single mass lesion in 14 (41.2%) patients. As an induction therapy, meth-otrexate-based regimen was administered in 29 (85.3%) patients. Only 14 of the 34 patients received 4 or more cycles of high-dose methotrexate (MTX). About 32.4% of the patients received radiation therapy (RT) during follow-up as a part of induction therapy. Five patients received only RT due to poor performance status. Ibrutinib was administered in 5 patients for refractory disease. It was determined that four or more cycles of MTX treatment increased progression-free survival (PFS) (p=0.031) and overall survival (OS) (p=0.012). Moreover, RT improved PFS (p=0.023). Considering that the complete response achieved by induction therapy influences long-term survival, achievement of the best response to the treatment regimens administered in combination with new agents may prolong survival (PFS: p=0.01, OS: p=0.023). Conclusion: The findings of this study indicate that the initial response to treatment is crucial. Additionally, it was found that high-dose MTX treatment should be administered for 4 cycles or more in order to achieve the best results. Furthermore, it was determined that ibrutinib monotherapy was well-tolerated in our patients with relapsed/refractory disease, with excellent clinical benefits. In conclusion, a combination therapy consisting of high-dose MTX, ibrutinib, and rituximab appears to be a promising initial treatment approach in appropriate patients.
dc.identifier.citationGüven, S., Yavuz, B., Erdoğan Yücel, E., Karataş, A. F., Özsan, G. H., Demirkan, F. ... Alacacıoğlu, İ. (2023). Clinical outcomes and treatment patterns of primary central nervous system lymphoma: Multicenter retrospective analysis. Eurasian Journal of Medicine and Oncology, 7(1), 49-56. https://dx.doi.org/10.14744/ejmo.2023.64688
dc.identifier.doi10.14744/ejmo.2023.64688
dc.identifier.endpage56
dc.identifier.issn2587-2400
dc.identifier.issue1
dc.identifier.scopus2-s2.0-85150168180
dc.identifier.scopusqualityN/A
dc.identifier.startpage49
dc.identifier.urihttps://dx.doi.org/10.14744/ejmo.2023.64688
dc.identifier.urihttps://hdl.handle.net/20.500.12511/10718
dc.identifier.volume7
dc.identifier.wos001135809500008en_US
dc.identifier.wosqualityN/A
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.institutionauthorBalık Aydın, Berrin
dc.institutionauthorSevindik, Ömür Gökmen
dc.language.isoen
dc.publisherKare Publishing
dc.relation.ispartofEurasian Journal of Medicine and Oncologyen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsAttribution-NonCommercial 4.0 International*
dc.rightsinfo:eu-repo/semantics/openAccess
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/*
dc.subjectIbrutinib
dc.subjectMethotrexate
dc.subjectPCNSL
dc.subjectRadiotherapy
dc.titleClinical outcomes and treatment patterns of primary central nervous system lymphoma: Multicenter retrospective analysis
dc.typeArticle

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