ASH 2022: Primary Central Nervous System Lymphoma Survival Improved with Consolidation Therapy

Consolidation with either whole-brain radiation therapy (WBRT) or autologous stem cell transplant (autoSCT) improves overall survival in patients with primary central nervous system lymphoma (PCNSL), regardless of first-line therapy, according to the results of a multicenter study.

PCNSL is a rare form of non-Hodgkin lymphoma with poor survival outcomes. High-dose methotrexate (HD-MTX)-based chemoimmunotherapy is the current standard for treatment, with or without combination high-dose cytarabine. Subsequent consolidation therapy with WBRT or autoSCT is preferred but is not performed in all cases. In this study, investigators sought to compare response rates and survival outcomes in PCSNL patients who received various HD-MTX-based chemoimmunotherapies with and without consolidation therapy.

Three high-intensity and two moderate-intensity regimens were used. Of the 250 patients included in the study, 45% received high-intensity treatment and 55% received moderate-intensity treatment. No difference in overall survival was seen between patients who received high- vs moderate-intensity treatment or between any of the different HD-MTX-based regimens. Patients who received consolidation therapy, however, had better responses and improved overall survival compared with those who didn’t receive consolidation therapy. Approximately one-third of patients received consolidation therapy in the study, of which approximately two-thirds received WBRT and one-third received autoSCT. No survival differences were observed based on consolidation therapy type.

Consolidation therapy was used more often in younger patients than older patients, so investigators sought to identify additional potential factors that may have impacted survival. Older age, worse performance status (≥2), and elevated lactate dehydrogenase (LDH) were all found to be predictive of greater risk for death. In patients with these risk factors, use of consolidation therapy reduced the risk for death by 56%.

Based on these results, the researchers suggested that PCNSL treatment algorithms should emphasize the use of consolidation therapy with WBRT or autoSCT following initial HD-MTX-based therapy, regardless of regimen.