High-dose cytarabine salvage therapy for recurrent primary CNS lymphoma

作者：Chamberlain Marc C^*

来源：Journal of Neuro-Oncology, 2016, 126(3): 545-550.

DOI：10.1007/s11060-015-1994-8

• Primary CNS lymphoma
• Refractory to high dose methotrexate
• Single agent high dose araC

Treatment of recurrent primary CNS lymphoma (PCNSL) though not standardized most often utilizes whole brain radiotherapy, re-challenge with high-dose methotrexate, or administration of an alkylating chemotherapy. High-dose cytarabine (HD-araC) has been advocated as an active agent in PCNSL but limited information exists regarding single agent activity in the recurrent setting. A retrospective review of 14 patients (10 males, 4 females: median age 60 years) with recurrent PCNSL treated at second recurrence with single agent HD-araC. HD-araC was administered at 3gm/m(2) over a 3-h infusion every 12 h for a total of 4 doses (defined as a cycle of therapy). GM-CSF was administered at conclusion of HD-araC. Patients were clinically and radiographically evaluated every 4-weeks. Common toxicity criteria Grade 3 or 4 toxicity included thrombocytopenia (11 patients; 79 %), anemia (10; 71 %), fatigue (8; 57 %), mucositis (8; 57 %), neutropenia (8; 57 %) and neutropenic fever (5; 36 %). No patient discontinued therapy due to toxicity nor were there any treatment-related deaths. Best response to HD-araC was stable disease in 6 patients (43 %), partial response in 5 (36 %) and progressive disease in 3 (21 %). Median progression free survival 3 months (range 2-5 months; 95 % CI 2-4 months) and progression free survival was 0 % at 6-months. Median survival after onset of HD-araC was 12 months (range 3-18+ months; 95 % CI 3-15 months). Single agent HD-araC has limited activity in recurrent PCNSL and is associated with significant toxicity in this small retrospective study.

• 出版日期2016-2