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Primary CNS Lymphoma in Immunocompetent Patients: Experience from Cancer Institute

Nikita Mehra, Prasanth Ganesan, Trivadi .

Abstract


Background: Primary CNS Lymphomas (PCNSL)are rare tumors which account for 1% of all lymphomas, 4-6% of all extranodal lymphomas, and about 3% of all CNS tumors.(1) We report the outcome of patients diagnosed and treated at our Centre over a 5-year period.

 

Methods: Cases of HIV negative PCNSL were identified from retrospective review of records of lymphomas diagnosed  between 2010 and 2015. All patients had biopsy proven   lymphoma and were treated with multiagent chemotherapy. Patients who were young and in good performance status received DeAngelis protocol [Methotrexate, Procarbazine and Vincristine (MPV), radiotherapy and high dose Cytarabine], while others received single agent chemotherapy +/-         radiotherapy. Rituximab (R) was used in a few patients.

 

Results: PCNSL- DLBCL constituted 2.3% of all the DLBCL cases treated during the same time period.Thirteen patients (Male to female ratio- 1:1.16, median age- 58 years) were treated in this period. Histology was diffuse B cell in 92% (n=12) and low grade T cell lymphoma in 8% (n=1).

 

Chemotherapy protocols used were: R-MPV (n=3), MPV(n=5); R-Methotrexate (n= 2), CHOP with intrathecal methotrexate (n=1), Methotrexate alone (n=1), R-Temozolamide (n=1).Consolidation WBRT was given in 53.8% (n=7) and Cytarabine given in 30.7% (n=4). 1 patient who achieved only a partial response with R-MPV underwent high dose    chemotherapy followed by autologous stem cell transplant.

 

Complete response was achieved at the end of planned    therapy in 46.15% (n=6). After a median follow-up of 27 months (0.5-53), 7 are alive with 6 being disease-free. Cause of death were progressive disease (n=4), myocardial infarction (n=1) and sudden cardiac arrest (n=1).

 

 

Median follow-up was 27 months (Range 0.5-53 months).  

Conclusion: We will continue to closely follow up the patients who are alive and disease-free (46%). There is a need to further select patients carefully for High dose chemotherapy followed by Autologous stem cell       transplant to generate higher survival rates.

 

Disclosures: No relevant conflicts of interest to declare

 

Keywords: primary CNS lymphoma, immunocompetent, chemotherapy


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