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Early response to high-dose methotrexate, vincristine, and procarbazine chemotherapy-adapted strategy for primary CNS lymphoma: no consolidation therapy for patients achieving early complete response.

Authors
 Yu Ri Kim  ;  Se Hoon Kim  ;  Jong Hee Chang  ;  Chang-Ok Suh  ;  Soo-Jeong Kim  ;  Yundeok Kim  ;  Doh Yu Hwang  ;  Ji Eun Jang  ;  Shin Young Hyun  ;  June-Won Cheong  ;  Yoo Hong Min  ;  Jin Seok Kim 
Citation
 ANNALS OF HEMATOLOGY, Vol.93(2) : 211-219, 2014 
Journal Title
 ANNALS OF HEMATOLOGY 
ISSN
 0939-5555 
Issue Date
2014
MeSH
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage* ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Autografts ; Brain Neoplasms/metabolism ; Brain Neoplasms/mortality ; Brain Neoplasms/pathology ; Brain Neoplasms/therapy* ; Brain Neoplasms/virology ; DNA, Viral/metabolism ; Disease-Free Survival ; Epstein-Barr Virus Infections/metabolism ; Epstein-Barr Virus Infections/mortality ; Epstein-Barr Virus Infections/pathology ; Epstein-Barr Virus Infections/therapy* ; Female ; Follow-Up Studies ; Gene Expression Regulation, Neoplastic/drug effects ; Gene Expression Regulation, Neoplastic/radiation effects ; Gene Expression Regulation, Viral/drug effects ; Gene Expression Regulation, Viral/radiation effects ; Herpesvirus 4, Human* ; Humans ; Lymphoma/metabolism ; Lymphoma/mortality ; Lymphoma/pathology ; Lymphoma/therapy* ; Lymphoma/virology ; Male ; Methotrexate/administration & dosage ; Methotrexate/adverse effects ; Middle Aged ; Procarbazine/administration & dosage ; Procarbazine/adverse effects ; RNA, Viral/metabolism ; Retrospective Studies ; Stem Cell Transplantation* ; Survival Rate ; Vincristine/administration & dosage ; Vincristine/adverse effects
Keywords
Primary central nervous system lymphoma ; High-dose methotrexate ; Consolidation ; Complete response ; Epstein-Barr virus
Abstract
Optimal treatment strategies for primary central nervous system lymphoma (PCNSL) have not been established. In this study, we investigated the treatment outcomes and prognostic factors of high-dose methotrexate, vincristine, and procarbazine (MVP) chemotherapy followed by an interim response-adapted intensification strategy in immunocompetent patients with PCNSL. We evaluated the evidence of infection with Epstein-Barr virus (EBV) in both brain tumor tissue and whole blood. Forty patients were retrospectively reviewed. Ten (25 %) patients who achieved complete response (CR) in the interim analysis did not receive any additional consolidation treatment after completion of planned high-dose MVP chemotherapy. Additional radiotherapy (n = 9) or autologous stem cell transplantation (ASCT) (n = 7) was performed in patients who did not achieve CR in the interim analysis. The median age was 55 years. The overall CR rate was 62.5 % (n = 25), and the objective response rate was 75.0 %. Two-year overall survival (OS) was 59.8 %, and 2-year progression-free survival was 47.1 %. Grade 3 or 4 neutropenia and thrombocytopenia occurred in 47.5 and 32.5 % of patients, respectively. Treatment-related mortality was 15.0 % (n = 6), and four patients developed delayed neurotoxicity. There was no evidence of EBV-encoded RNA expression in brain tumor tissue. Ten (29.4 %) of 34 patients showed detectable EBV-DNA in whole blood. Poor performance status and EBV-DNA positivity in whole blood were significantly associated with inferior OS (p = 0.032, p = 0.023, respectively). We suggest that high-dose MVP chemotherapy followed by an early response-adapted intensification strategy may be effective and minimize the number of patients who receive radiotherapy or ASCT in the early course of treatment.
Full Text
http://link.springer.com/article/10.1007%2Fs00277-013-1853-7
DOI
10.1007/s00277-013-1853-7
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Se Hoon(김세훈) ORCID logo https://orcid.org/0000-0001-7516-7372
Kim, Soo Jeong(김수정) ORCID logo https://orcid.org/0000-0001-8859-3573
Kim, Yu Ri(김유리) ORCID logo https://orcid.org/0000-0001-5505-0142
Kim, Yun Deok(김윤덕) ORCID logo https://orcid.org/0000-0002-5336-7936
Kim, Jin Seok(김진석) ORCID logo https://orcid.org/0000-0001-8986-8436
Min, Yoo Hong(민유홍) ORCID logo https://orcid.org/0000-0001-8542-9583
Suh, Chang Ok(서창옥)
Chang, Jong Hee(장종희)
Jang, Ji Eun(장지은) ORCID logo https://orcid.org/0000-0001-8832-1412
Cheong, June-Won(정준원) ORCID logo https://orcid.org/0000-0002-1744-0921
Hyun, Shin Yong(현신영)
Hwang, Doh Yu(황도유)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98028
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