Factors Influencing the Response to High Dose Methotrexate-based Vincristine and Procarbazine Combination Chemotherapy for Primary Central Nervous System Lymphoma.
10.3346/jkms.2011.26.4.551
- Author:
Kang Hyun SUNG
1
;
Eun Hee LEE
;
Young Zoon KIM
Author Information
1. Department of Neurosurgery and Division of Neurooncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. yzkim@skku.edu
- Publication Type:Original Article
- Keywords:
Central Nervous System;
Lymphoma;
Response;
Prognosis;
Survival;
Methotrexate;
Chemotherapy
- MeSH:
Adult;
Age Factors;
Aged;
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use;
Central Nervous System Neoplasms/*drug therapy/mortality;
Contrast Media/chemistry/diagnostic use;
DNA-Binding Proteins/metabolism;
Disease-Free Survival;
Drug Administration Schedule;
Female;
Follow-Up Studies;
Gadolinium/chemistry/diagnostic use;
Humans;
Interferon Regulatory Factors/metabolism;
Lymphoma/*drug therapy/mortality;
Magnetic Resonance Imaging;
Male;
Methotrexate/*administration & dosage;
Middle Aged;
Odds Ratio;
Procarbazine/*administration & dosage;
Prospective Studies;
Recurrence;
Severity of Illness Index;
Transcription Factors/metabolism;
Tumor Suppressor Protein p53/metabolism;
Vincristine/*administration & dosage
- From:Journal of Korean Medical Science
2011;26(4):551-560
- CountryRepublic of Korea
- Language:English
-
Abstract:
The authors investigated objective response rate to high dose methotrexate (HDMTX)-based combination chemotherapy in primary central nervous system lymphoma (PCNSL), and sought to identify factors that influence response to HDMTX-based combination therapy. Prospective observational analysis was performed on 52 PCNSL patients. All patients received HDMTX (3.5 g/m2) and vincristine (1.4 mg/m2/day) for one day during weeks 1, 3, 5, 7, and 9, and procarbazine (100 mg/m2/day) for one week during weeks 1, 5, and 9. Forty-one patients (78.8%) achieved complete or partial remission. Higher objective response rates were observed for patients with: 1) age < 60 yr; 2) Eastern Cooperative Oncology Group (ECOG) performance score of < 2; 3) low risk status as defined by the International Extranodal Lymphoma Study Group; 4) p53 positivity; 5) XBP-1 negativity; 6) MUM-1 negativity; and 7) homogenous gadolinium enhancement in MR images. Multivariate analysis showed that ECOG performance score of < 2, low risk, negativity for XBP-1, homogenous gadolinium enhancement by MRI, and response to chemotherapy were associated with longer overall survival. In particular, it is interesting to note that patients with a PCNSL that is homogenously enhanced by gadolinium have a higher objective response rate, and a longer progression-free survival and overall survival.
