LONG-TERM SURVIVAL IN PRIMARY CNS LYMPHOMA

Purpose: We have previously reported on 31 patients with primary CNS l ymphoma (PCNSL) treated between 1986 and 1992 with methotrexate (MTX), cranial radiotherapy (RT), and high-dose cytarabine who remained free of disease longer than historical controls. Patients and Methods: We performed a follow-up analysis of our original cohort and now report t heir long-term survival and late treatment-related toxicity. Results: The median cause-specific survival was 42 months, with a five-year sur vival of 22.3% compared with 3% to 4% in historical controls treated w ith RT alone. Age less than 50 years at diagnosis was a significant pr ognostic factor for survival (P = .01). Median disease-free survival w as 40.3 months; 15 patients relapsed, all but one in the CNS. Late tre atment-related toxicity was observed in nearly one third of patients a nd those more than 60 years of age were at substantially higher risk ( P < .0001). Conclusion: Combined modality therapy for PCNSL has improv ed survival, but relapse is common and late neurologic toxicity is a s ignificant complication. Although this approach is highly effective fo r younger patients, efficacious but less neurotoxic regimens need to b e developed for older patients. (C) 1998 by American Society of Clinic al Oncology.