CHOD/BVAM regimen plus radiotherapy in patients with primary CNS non-Hodgkin's lymphoma

Purpose: To assess the efficacy and toxicity, including long-term neurotoxi city, of combined therapy with the CHOD/BVAM regimen given before cranial r adiotherapy in the treatment of primary CNS lymphoma (PCNSL). Methods and Materials: Thirty-one consecutive patients with PCNSL were trea ted with one cycle of cyclophosphamide, doxorubicin, vincristine, and dexam ethasone (CHOD) and two of carmustine (BCNU), vincristine, cytosine arabino side, and methotrexate (BVAM), followed by cranial radiotherapy (45 Gy whol e brain plus a 10-Gy boost for single lesions). The median age was 59 years (range 21-70) and 39% had poor performance status. The median follow-up of patients was 4.1 years (range 2.7-9.0). Results: Twenty-one patients had no PCNSL at the end of treatment. The 5-ye ar actuarial probability of survival was 31% (95% confidence interval [CI]: 11%-57%), with a median survival of 38 months. Patients < 60 years had a s urvival significantly longer than those <greater than or equal to> 60 years (4-year survival: 58% (95% CI: 34-82%) vs. 29% (95% CI: 5-53%), respective ly; p = 0.04). Two patients died during chemotherapy from pulmonary embolis m and bronchopneumonia, respectively, with no evidence of PCNSL at the auto psy. Dementia probably related to treatment occurred in 5 (62%) of the 8 pa tients 60 years and older, and 4 of them died without evidence of relapse o f PCNSL. Dementia correlated with developing brain atrophy and leuco-enceph alopathy on serial CT or MR scans. Conclusion: This regimen can be given with the planned dose intensity to pa tients aged less than 70 years, and produces better survival than that repo rted with radiotherapy alone; however, dementia occurs in the majority of p atients aged 60 years of age or more. (C) 2001 Elsevier Science Inc.