Journal of Neuro-Oncology | 2021
A single-center retrospective analysis of outcome measures and consolidation strategies for relapsed and refractory primary CNS lymphoma
Abstract
Background Relapsed or refractory primary CNS lymphoma (rrPCNSL) is a rare and challenging malignancy for which better evidence is needed to guide management. Methods We present a retrospective cohort of 66 consecutive patients with rrPCNSL treated at the University of Washington between 2000 and 2020. Immunosuppressed and secondary CNS lymphoma patients were excluded. Results During a median follow-up of 40.5\xa0months from initial diagnosis, median OS for relapsed disease was 14.1 (0.2–88.5) months and median PFS was 11.0 (0.2–73.9) months. At diagnosis (r 2 \xa0=\xa00.85, p\xa0<\xa00.001), first relapse (r 2 \xa0=\xa00.69, p\xa0<\xa00.001), multiple relapses (r 2 \xa0=\xa00.97, p\xa0<\xa00.001) PFS was highly correlated with OS. In contrast, there was no correlation between the duration of subsequent progression-free intervals. No difference in PFS or OS was seen between CSF or intraocular relapse and parenchymal relapse. Patients reinduced with high-dose methotrexate-based (HD-MTX) regimens had an overall response rate (ORR) of 86.7%. Consolidation with autologous stem cell transplant (ASCT) was associated with longer PFS compared to either no consolidation (p\xa0=\xa00.01) and trended to longer PFS when compared to other consolidation strategies (p\xa0=\xa00.06). OS was similarly improved in patients consolidated with ASCT compared with no consolidation (p\xa0=\xa00.04), but not compared with other consolidation (p\xa0=\xa00.22). Although patients receiving ASCT were younger, KPS, sex, and number of recurrences were similar between consolidation groups. A multivariate analysis confirmed an independent effect of consolidation group on PFS (p\xa0=\xa00.01), but not OS. Conclusions PFS may be a useful surrogate endpoint which predicts OS in PCNSL. Consolidation with ASCT was associated with improved PFS\xa0in rrPCNSL.