Cognitive outcomes and long-term follow-up results after enhanced chemotherapy delivery for primary central nervous system lymphoma

Leslie D. McAllister, Nancy Doolittle, Paul E. Guastadisegni, Dale Kraemer, Cynthia A. Lacy, John R. Crossen, Edward Neuwelt

Research output: Contribution to journalArticle

173 Citations (Scopus)

Abstract

OBJECTIVE: Patients with non-acquired immunodeficiency syndrome-related primary central nervous system lymphomas have the potential to achieve durable complete responses without radiotherapy, with treatment using enhanced chemotherapy delivery with blood-brain barrier disruption (BBBD). Reported 5-year survival rates with combined chemotherapy and radiotherapy were generally only 9 to 22% and were associated, in one study, with an overall 32% incidence of overt dementia and ataxia, which are dramatically increased among patients more than 60 years of age. METHODS: At the Oregon Health Sciences University, 111 consecutive patients with non-acquired immunodeficiency syndrome-related central nervous system lymphomas were prospectively treated with methotrexate-based, BBBD-enhanced chemotherapy and underwent formal neuropsychological evaluations. Of those, 74 patients had no systemic lymphoma and had received no prior irradiation; those 74 patients are described in this report. RESULTS: The estimated 5-year survival rate for this group was 42%, and the median survival time was 40.7 months. Overall, 48 patients (65%) exhibited complete responses and 36 patients continued to exhibit complete responses after 1 year of BBBD-enhanced chemotherapy. Of those 36 patients, none demonstrated evidence of cognitive loss in neuropsychological tests and/or clinical examinations. CONCLUSION: BBBD- enhanced chemotherapy delivery, without subsequent radiotherapy, resulted in favorable survival and cognitive outcomes for patients with primary central nervous system lymphomas who had not previously undergone irradiation. A cooperative multicenter study of intravenous chemotherapy without radiotherapy versus BBBD-enhanced chemotherapy would address the feasibility and necessity of performing a Phase III study for these rare central nervous system malignancies.

Original languageEnglish (US)
Pages (from-to)51-61
Number of pages11
JournalNeurosurgery
Volume46
Issue number1
StatePublished - Jan 2000

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Lymphoma
Central Nervous System
Drug Therapy
Blood-Brain Barrier
Radiotherapy
Survival Rate
Survival
Neuropsychological Tests
Ataxia
Methotrexate
Multicenter Studies
Dementia
Incidence
Health
Neoplasms

Keywords

  • Blood-brain barrier disruption
  • Enhanced chemotherapy
  • Primary brain tumor
  • Primary central nervous system lymphoma

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Cognitive outcomes and long-term follow-up results after enhanced chemotherapy delivery for primary central nervous system lymphoma. / McAllister, Leslie D.; Doolittle, Nancy; Guastadisegni, Paul E.; Kraemer, Dale; Lacy, Cynthia A.; Crossen, John R.; Neuwelt, Edward.

In: Neurosurgery, Vol. 46, No. 1, 01.2000, p. 51-61.

Research output: Contribution to journalArticle

McAllister, Leslie D. ; Doolittle, Nancy ; Guastadisegni, Paul E. ; Kraemer, Dale ; Lacy, Cynthia A. ; Crossen, John R. ; Neuwelt, Edward. / Cognitive outcomes and long-term follow-up results after enhanced chemotherapy delivery for primary central nervous system lymphoma. In: Neurosurgery. 2000 ; Vol. 46, No. 1. pp. 51-61.
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abstract = "OBJECTIVE: Patients with non-acquired immunodeficiency syndrome-related primary central nervous system lymphomas have the potential to achieve durable complete responses without radiotherapy, with treatment using enhanced chemotherapy delivery with blood-brain barrier disruption (BBBD). Reported 5-year survival rates with combined chemotherapy and radiotherapy were generally only 9 to 22{\%} and were associated, in one study, with an overall 32{\%} incidence of overt dementia and ataxia, which are dramatically increased among patients more than 60 years of age. METHODS: At the Oregon Health Sciences University, 111 consecutive patients with non-acquired immunodeficiency syndrome-related central nervous system lymphomas were prospectively treated with methotrexate-based, BBBD-enhanced chemotherapy and underwent formal neuropsychological evaluations. Of those, 74 patients had no systemic lymphoma and had received no prior irradiation; those 74 patients are described in this report. RESULTS: The estimated 5-year survival rate for this group was 42{\%}, and the median survival time was 40.7 months. Overall, 48 patients (65{\%}) exhibited complete responses and 36 patients continued to exhibit complete responses after 1 year of BBBD-enhanced chemotherapy. Of those 36 patients, none demonstrated evidence of cognitive loss in neuropsychological tests and/or clinical examinations. CONCLUSION: BBBD- enhanced chemotherapy delivery, without subsequent radiotherapy, resulted in favorable survival and cognitive outcomes for patients with primary central nervous system lymphomas who had not previously undergone irradiation. A cooperative multicenter study of intravenous chemotherapy without radiotherapy versus BBBD-enhanced chemotherapy would address the feasibility and necessity of performing a Phase III study for these rare central nervous system malignancies.",
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