Department of Neurology (P.R., M.W.), University Hospital Zurich, Switzerland.
Neurology. 2012 Aug 28;79(9):890-6. doi: 10.1212/WNL.0b013e318266fcb2. Epub 2012 Aug 15.
To assess the outcome of elderly patients with primary CNS lymphoma (PCNSL) treated within the G-PCNSL-SG-1 trial.
We reviewed response, toxicity, and survival of patients with PCNSL aged 70 or more enrolled in the G-PCNSL-SG-1 trial.
A total of 126 of the 526 eligible patients (24%) and 66 of 318 patients (21%) in the per protocol population were aged 70 or more. Among all eligible patients, the rate of complete and partial responses (CR+PR) to HD-MTX-based chemotherapy was 44% in the elderly vs 57% in the younger patients (p = 0.016). Toxicity was age-independent except for a higher rate of grade III/IV leukopenia in the elderly (34% vs 21%, p = 0.007). Death on therapy was more frequent (18% vs 11%; p = 0.027), and progression-free survival (PFS) (4.0 vs 7.7 months, p = 0.014) and overall survival (12.5 vs 26.2 months, p < 0.001) inferior, in the elderly. A striking difference between younger and elderly patients was the PFS of CR patients of 35.0 in the younger vs 16.1 in the elderly patients (p = 0.024). Elderly patients were treated less often and less aggressively at salvage. However, age was not associated with survival from salvage whole brain radiotherapy in patients progressing during primary HD-MTX-based chemotherapy (p = 0.633).
Lower response rate and higher mortality on HD-MTX-based chemotherapy as well as lower PFS of CR patients and less salvage therapy contribute to the poor prognosis of elderly patients with PCNSL.
评估 G-PCNSL-SG-1 试验中治疗的原发性中枢神经系统淋巴瘤（PCNSL）老年患者的结局。
我们回顾了 G-PCNSL-SG-1 试验中年龄在 70 岁及以上的 PCNSL 患者的反应、毒性和生存情况。
在符合方案人群中，共有 526 名合格患者中的 126 名（24%）和 318 名患者中的 66 名（21%）年龄在 70 岁及以上。在所有合格患者中，接受基于 HD-MTX 的化疗的完全和部分缓解（CR+PR）率在老年患者中为 44%，在年轻患者中为 57%（p=0.016）。毒性与年龄无关，但老年患者白细胞减少症（III/IV 级）的发生率较高（34% vs 21%，p=0.007）。治疗期间死亡率较高（18% vs 11%；p=0.027），无进展生存期（PFS）（4.0 个月 vs 7.7 个月，p=0.014）和总生存期（OS）（12.5 个月 vs 26.2 个月，p<0.001）较差。年轻患者和老年患者之间的一个显著差异是年轻患者的 CR 患者的 PFS 为 35.0，而老年患者的 PFS 为 16.1（p=0.024）。在挽救性治疗中，老年患者的治疗较少且治疗强度较低。然而，在原发性 HD-MTX 为基础的化疗进展期间接受挽救性全脑放疗的患者中，年龄与生存无关（p=0.633）。
基于 HD-MTX 的化疗反应率较低和死亡率较高、CR 患者的 PFS 较低以及挽救性治疗较少，导致 PCNSL 老年患者预后较差。
