First-line treatment and outcome of elderly patients with primary central nervous system lymphoma (PCNSL) - a systematic review and individual patient data meta-analysis

Kasenda, B. and Ferreri, A. J. M. and Marturano, E. and Forst, D. and Bromberg, J. and Ghesquieres, H. and Ferlay, C. and Blay, J. Y. and Hoang-Xuan, K. and Pulczynski, E. J. and Fosså, A. and Okoshi, Y. and Chiba, S. and Fritsch, K. and Omuro, A. and O'Neill, B. P. and Bairey, O. and Schandelmaier, S. and Gloy, V. and Bhatnagar, N. and Haug, S. and Rahner, S. and Batchelor, T. T. and Illerhaus, G. and Briel, M.. (2015) First-line treatment and outcome of elderly patients with primary central nervous system lymphoma (PCNSL) - a systematic review and individual patient data meta-analysis. Annals of Oncology, 26 (7). pp. 1305-1313.

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To investigate prognosis and effects of first-line therapy in elderly primary central nervous system lymphoma (PCNSL) patients.; A systematic review of studies about first-line therapy in immunocompetent patients ≥60 years with PCNSL until 2014 and a meta-analysis of individual patient data from eligible studies and international collaborators were carried out.; We identified 20 eligible studies; from 13 studies, we obtained individual data of 405 patients, which were pooled with data of 378 additional patients (N = 783). Median age and Karnofsky Performance Score (KPS) was 68 years (range: 60-90 years) and 60% (range: 10%-100%), respectively. Treatments varied greatly, 573 (73%) patients received high-dose methotrexate (HD-MTX)-based therapy. A total of 276 patients received whole-brain radiotherapy (median 36 Gy, range 28.5-70 Gy). KPS ≥ 70% was the strongest prognostic factor for mortality [hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.41-0.62]. After a median follow-up of 40 months, HD-MTX-based therapy was associated with improved survival (HR 0.70, 95% CI 0.53-0.93). There was no difference between HD-MTX plus oral chemotherapy and more aggressive HD-MTX-based therapies (HR 1.39, 95% CI 0.90-2.15). Radiotherapy was associated with an improved survival, but correlated with an increased risk for neurological side-effects (odds ratio 5.23, 95% CI 2.33-11.74).; Elderly PCNSL patients benefit from HD-MTX-based therapy, especially if combined with oral alkylating agents. More aggressive HD-MTX protocols do not seem to improve outcome. WBRT may improve outcome, but is associated with increased risk for neurological side-effects. Prospective trials for elderly PCNSL patients are warranted.
Faculties and Departments:03 Faculty of Medicine > Departement Klinische Forschung > Clinical Epidemiology and Biostatistics CEB > Klinische Epidemiologie (Bucher H)
UniBasel Contributors:Kasenda, Benjamin
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Oxford University Press
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:09 Oct 2017 06:44
Deposited On:09 Oct 2017 06:44

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