If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  ICML: Older Patients with Primary Central Nervous System Lymphoma Have Poorer Long-Term Survival than Younger Patients By Claudia Orellana LUGANO, SWITZERLAND -- June 18, 2002 -- Older patients with primary non-Hodgkin’s lymphoma of the central nervous system (CNS) have poorer long-term survival rates than their younger counterparts, whether treated with chemotherapy alone or with chemotherapy followed by cranial radiotherapy. Dr. Eric Bessell, from the department of clinical oncology, Nottingham City Hospital, United Kingdom, presented the findings here Friday at the 8th International Conference on Malignant Lymphoma (ICML). Dr. Bessell and colleagues from Nottingham City Hospital and from the departments of neurology and haematology and radiation oncology, Institut Catala d’Oncologia, Barcelona, Spain, led the two-centre study. Their investigation is part of a wider evaluation of whether the factors of the International Prognostic Index (IPI) for non-Hodgkin’s lymphoma are relevant for primary CNS lymphoma. The researchers analysed data from 77 patients diagnosed with primary CNS lymphoma since 1986: 57 patients were treated with one cycle of cyclophosphamide, doxorubicin, vincristine, and dexamethasone followed by two cycles of carmustine, vincristine, cytosine arabinoside, and methotrexate; 20 patients received two cycles of carmustine, vincristine, cytosine arabinoside, and methotrexate followed by cranial radiotherapy (30.6-55 Gy). Patients’ median age was 60 years (range 21 to 78 years), and 35 percent had poor performance status (ECOG/WHO grade 3 or 4). The researchers found that the median survival time was 54.5 months for the 35 patients younger than 60 years, 20.2 months for the 32 patients aged 60-69 years, and 8.7 months for the 10 patients aged 70 or older. The actuarial probability of survival for patients aged 60 or younger was 37.1 percent at five years and 31.8 percent at 10 years. The latest relapse was at 68 months. Six patients survived more than six years without relapse, and three patients survived for more than 10 years; the longest relapse-free survival was 15 years. Significant neurotoxicity was found only in patients older than 60 years at the time of diagnosis. IPI for non-Hodgkin’s lymphoma comprises five factors: age 60 or older; performance status 2 or greater; stage III, IV versus I, II; raised serum lactate dehydrogenase (LDH); and more than one extranodal site. "I believe we can probably take two of those out. More than one extranodal site never happens with this disease, and serum LDH may not be relevant to a CNS disease. So that leaves three factors: age, performance status, and stage," said Dr. Bessell. "We have also done a multivariate analysis and we found that these three factors were very highly significant indeed." He said improving prognosis indicators will strengthen comparison between the many phase II studies around the world. "In patients under 60, I think we can say this is a curable disease now, which was not thought to be the case years ago. The problem for all of us is dealing with the patients over 60. Although the median survival is still 20 months, which is better than it used to be, and the five-year survival is 23 percent, our data says that we haven’t got any 10-year survivors yet. And in the over-70s its even worse."
|
