Management and outcome of primary CNS lymphoma in the modern era: An LOC network study

Caroline Houillier (1) , Carole Soussain , Hervé Ghesquières , Pierre Soubeyran , Olivier Chinot , Luc Taillandier (2) , Thierry Lamy (3) , Sylvain Choquet , Guido Ahle (4) , Gandhi Damaj , Philippe Agapé , Cécile Moluçon-Chabrot , Alexandra Amiel , Vincent Delwail (5) , Michel Fabbro , Fabrice Jardin , Adrien Chauchet , Marie-Pierre Moles-Moreau , Franck Morschhauser , Olivier Casasnovas , Rémy Gressin , Luc-Matthieu Fornecker , Julie Abraham , Jean-Pierre Marolleau , Adrian Tempescul , Chantal Campello , Philippe Colin , Jérôme Tamburini , Kamel Laribi , Caroline Serrier , Corinne Haioun , Safia Chebrek , Anna Schmitt , Marie Blonski , Roch Houot , Eileen Boyle , Jacques-Olivier Bay , Lucie Oberic , Emeline Tabouret , Agathe Waultier , Nadine Martin-Duverneuil , Valérie Touitou , Nathalie Cassoux , Aurélie Kas , Karima Mokhtari , Frederic Charlotte , Agusti Alentorn , Loïc Feuvret , Magali Le Garff-Tavernier , Myrto Costopoulos , Bertrand Mathon , Matthieu Peyre , Daniel Delgadillo , Hassen Douzane , Diane Genet , Bachir Aidaoui , Khê Hoang-Xuan , Emmanuel Gyan (6)

1 CIC - Centre d’Investigation Clinique [Tours] CIC 1415
2 INP - Institut de neurophysiopathologie
3 MICMAC - Microenvironment, Cell Differentiation, Immunology and Cancer
4 CHU Pontchaillou [Rennes]
5 CIC - Poitiers
6 Institut Curie [Paris]

Objective - Real-life studies on patients with primary CNS lymphoma (PCNSL) are scarce. Our objective was to analyze, in a nationwide population-based study, the current medical practice in the management of PCNSL. Methods - The French oculo-cerebral lymphoma network (LOC) database prospectively records all newly diagnosed PCNSL cases from 32 French centers. Data of patients diagnosed between 2011 and 2016 were retrospectively analyzed. Results - We identified 1,002 immunocompetent patients (43% aged >70 years, median Karnofsky Performance Status [KPS] 60). First-line treatment was high-dose methotrexate-based chemotherapy in 92% of cases, with an increasing use of rituximab over time (66%). Patients <60 years of age received consolidation treatment in 77% of cases, consisting of whole-brain radiotherapy (WBRT) (54%) or high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) (23%). Among patients >60 years of age, WBRT and HCT-ASCT consolidation were administered in only 9% and 2%, respectively. The complete response rate to initial chemotherapy was 50%. Median progression-free survival was 10.5 months. For relapse, second-line chemotherapy, HCT-ASCT, WBRT, and palliative care were offered to 55%, 17%, 10%, and 18% of patients, respectively. The median, 2-year, and 5-year overall survival was 25.3 months, 51%, and 38%, respectively (<60 years: not reached [NR], 70%, and 61%; >60 years: 15.4 months, 44%, and 28%). Age, KPS, sex, and response to induction CT were independent prognostic factors in multivariate analysis. Conclusions - Our study confirms the increasing proportion of elderly within the PCNSL population and shows comparable outcome in this population-based study with those reported by clinical trials, reflecting a notable application of recent PCNSL advances in treatment.

Domains: Life Sciences [q-bio]; Cancer

Caroline Houillier, Carole Soussain, Hervé Ghesquières, Pierre Soubeyran, Olivier Chinot, et al.. Management and outcome of primary CNS lymphoma in the modern era: An LOC network study. Neurology, 2020, 94 (10), pp.e1027-e1039. ⟨10.1212/WNL.0000000000008900⟩. ⟨hal-02442415⟩