TY - JOUR
T1 - Long term outcomes in older patients with primary central nervous system lymphoma
T2 - an analysis of the Texas Cancer Registry
AU - Burns, Ethan A.
AU - Sanchez, Cesar Gentille
AU - Mathur, Sunil
AU - Guerrero, Carlo
AU - Muhsen, Ibrahim N.
AU - Sarfraz, Humaira
AU - Hu, Chih Chi Andrew
AU - Tang, Chih Hang Anthony
AU - Shah, Shilpan S.
AU - Tremont, Ivo W.
AU - Teh, Bin
AU - Ganguly, Siddhartha
AU - Pingali, Sai Ravi Kiran
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2023/5
Y1 - 2023/5
N2 - Primary central nervous system lymphoma (PCNSL) is an aggressive subtype of non-Hodgkin lymphoma that carries a poor prognosis in the elderly. The aim of this study is to investigate treatment patterns and survival trends in patients ≥ 65 years with PCNSL through data provided by the Texas Cancer Registry. Adults ≥ 65 years diagnosed with PCNSL and followed between 1995–2017 were identified and separated into three eras: 1995–2003, 2004–2012, and 2013–2017. Baseline covariates compared included patient demographics and treatments administered. Pearson’s chi-squared test and Cox proportional hazard models compared covariates; overall survival (OS) and disease-specific survival (DSS) were assessed via Kaplan–Meier methodology. There were 375 patients; 104 (27.7%) in 1995–2003, 146 (38.9%) in 2004–2012, and 125 (33.3%) in 2013–2017. There were 50 (48.1%), 55 (37.7%), and 31 (24.8%) in 1995–2003, 2004–2012, and 2013–2017, respectively, that did not receive treatment. At last follow up, 101 (97.1%), 130 (89.0%), and 94 (75.2%) in each era died, of which 89 (85.6%), 112 (76.7%), and 70 (56.0%) were attributed to PCNSL. Median OS per era was eight (95% confidence interval [CI] 5.06–10.93), six (95% CI, 2.30–9.69), and five months (95% CI, 2.26–7.73) (p = 0.638). DSS per era was nine (95% CI: 0.00, 26.53), 10 (95% CI: 5.14, 14.86), and 19 (95% CI, 0.00–45.49) (p = 0.931) months. Spinal cord as primary disease site (HR: 0.668 [95% CI, 0.45–0.99], p = 0.049), and chemotherapy (HR 0.532 [95% CI, 0.42–0.673], p = < 0.001) or chemotherapy + radiation (HR, 0.233 [95% CI, 0.11–0.48] p < 0.001) had better outcomes compared to no therapy or radiation therapy alone. Survival in older patients ≥ 65 with PCNSL has not improved per our analysis of the TCR from 1995–2017 despite increasing trends of treatment utilization. Strategies to augment recruitment of older individuals in trials are needed in order to determine who would derive treatment benefit and minimize treatment toxicities.
AB - Primary central nervous system lymphoma (PCNSL) is an aggressive subtype of non-Hodgkin lymphoma that carries a poor prognosis in the elderly. The aim of this study is to investigate treatment patterns and survival trends in patients ≥ 65 years with PCNSL through data provided by the Texas Cancer Registry. Adults ≥ 65 years diagnosed with PCNSL and followed between 1995–2017 were identified and separated into three eras: 1995–2003, 2004–2012, and 2013–2017. Baseline covariates compared included patient demographics and treatments administered. Pearson’s chi-squared test and Cox proportional hazard models compared covariates; overall survival (OS) and disease-specific survival (DSS) were assessed via Kaplan–Meier methodology. There were 375 patients; 104 (27.7%) in 1995–2003, 146 (38.9%) in 2004–2012, and 125 (33.3%) in 2013–2017. There were 50 (48.1%), 55 (37.7%), and 31 (24.8%) in 1995–2003, 2004–2012, and 2013–2017, respectively, that did not receive treatment. At last follow up, 101 (97.1%), 130 (89.0%), and 94 (75.2%) in each era died, of which 89 (85.6%), 112 (76.7%), and 70 (56.0%) were attributed to PCNSL. Median OS per era was eight (95% confidence interval [CI] 5.06–10.93), six (95% CI, 2.30–9.69), and five months (95% CI, 2.26–7.73) (p = 0.638). DSS per era was nine (95% CI: 0.00, 26.53), 10 (95% CI: 5.14, 14.86), and 19 (95% CI, 0.00–45.49) (p = 0.931) months. Spinal cord as primary disease site (HR: 0.668 [95% CI, 0.45–0.99], p = 0.049), and chemotherapy (HR 0.532 [95% CI, 0.42–0.673], p = < 0.001) or chemotherapy + radiation (HR, 0.233 [95% CI, 0.11–0.48] p < 0.001) had better outcomes compared to no therapy or radiation therapy alone. Survival in older patients ≥ 65 with PCNSL has not improved per our analysis of the TCR from 1995–2017 despite increasing trends of treatment utilization. Strategies to augment recruitment of older individuals in trials are needed in order to determine who would derive treatment benefit and minimize treatment toxicities.
KW - Chemotherapy
KW - Geriatric
KW - Older
KW - Primary Central Nervous System Lymphoma
KW - Radiation
KW - Spinal Cord
KW - Survival
KW - Central Nervous System Neoplasms/therapy
KW - Humans
KW - Texas/epidemiology
KW - Central Nervous System
KW - Lymphoma, Non-Hodgkin/epidemiology
KW - Adult
KW - Registries
KW - Aged
UR - http://www.scopus.com/inward/record.url?scp=85150173875&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150173875&partnerID=8YFLogxK
U2 - 10.1007/s00277-023-05140-6
DO - 10.1007/s00277-023-05140-6
M3 - Article
C2 - 36922432
AN - SCOPUS:85150173875
SN - 0939-5555
VL - 102
SP - 1111
EP - 1120
JO - Annals of Hematology
JF - Annals of Hematology
IS - 5
ER -