Survival, neurocognitive function, and health-related quality of life outcomes after rituximab-methotrexate, BCNU, teniposide, and prednisolone for primary CNS lymphoma: Final Results of the HOVON 105 / ALLG NHL 24 Study
Bromberg, Jacoline E C; Issa, Samar; van der Holt, Bronno; van der Meulen, Matthijs; Dirven, Linda; Minnema, Monique C; Seute, Tatjana; Durian, Marc; Cull, Gavin; van der Poel, Marjolein W M; Stevens, Wendy B C; Zijlstra, Josee M; Brandsma, Dieta; Nijland, Marcel; Mason, Kylie D; Beeker, Aart; Abrahamse-Testroote, Martine C J; van den Bent, Martin J; de Jong, Daphne; Doorduijn, Jeanette K
(2024) Neuro-oncology, volume 26, issue 4, pp. 724 - 734
(Article)
Abstract
BACKGROUND: Studies on the efficacy of rituximab in primary CNS lymphoma (PCNSL) reported conflicting results. Our international randomized phase 3 study showed that the addition of rituximab to high-dose methotrexate, BCNU, teniposide, and prednisolone (MBVP) in PCNSL was not efficacious in the short term. Here we present long-term results after
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a median follow-up of 82.3 months. METHODS: One hundred and ninety-nine eligible newly diagnosed, nonimmunocompromised patients with PCNSL aged 18-70 years with WHO performance status 0-3 was randomized between treatment with MBVP chemotherapy with or without rituximab, followed by high-dose cytarabine consolidation in responding patients, and reduced-dose WBRT in patients aged ≤ 60 years. Event-free survival was the primary endpoint. Overall survival rate, neurocognitive functioning (NCF), and health-related quality of life (HRQoL) were additionally assessed, with the IPCG test battery, EORTC QLQ-C30 and QLQ-BN20 questionnaires, respectively. RESULTS: For event-free survival, the hazard ratio was 0.85, 95% CI 0.61-1.18, P = .33. Overall survival rate at 5 years for MBVP and R-MBVP was 49% (39-59) and 53% (43-63) respectively. In total, 64 patients died in the MBVP arm and 55 in the R-MBVP arm, of which 69% were due to PCNSL. At the group level, all domains of NCF and HRQoL improved to a clinically relevant extent after treatment initiation, and remained stable thereafter up to 60 months of follow-up, except for motor speed which deteriorated between 24 and 60 months. Although fatigue improved initially, high levels persisted in the long term. CONCLUSIONS: Long-term follow-up confirms the lack of added value of rituximab in addition to MBVP and HD-cytarabine for PCNSL.
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Keywords: PCNSL, health-related quality of life, neurocognitive function, rituximab, treatment, Clinical Neurology, Oncology, Cancer Research
ISSN: 1522-8517
Publisher: Oxford University Press
Note: Publisher Copyright: © The Author(s) 2023.
(Peer reviewed)