Rituximab, methotrexate, procarbazine and lomustine (R-MPL) for the treatment of primary Central nervous system lymphoma

Eyal Lebel; Neta Goldschmidt; Tali Siegal; Alexander Lossos; Shai Rosenberg; Chen Makranz; Eduard Linetski; Moshe E. Gatt; Alexander Gural; Revital Saban; David Lavie; Vladimir Vainstein; Eran Zimran; Batia Avni; Sigal Grisaro; Adir Shaulov; Boaz Nachmias

doi:10.1080/10428194.2022.2064996

Rituximab, methotrexate, procarbazine and lomustine (R-MPL) for the treatment of primary Central nervous system lymphoma

Eyal Lebel^*, Neta Goldschmidt, Tali Siegal, Alexander Lossos, Shai Rosenberg, Chen Makranz, Eduard Linetski, Moshe E. Gatt, Alexander Gural, Revital Saban, David Lavie, Vladimir Vainstein, Eran Zimran, Batia Avni, Sigal Grisaro, Adir Shaulov, Boaz Nachmias

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

The optimal high-dose methotrexate (HDMTX)-based combination therapy for primary central nervous system lymphoma is unknown. We report our experience with rituximab, HDMTX, procarbazine and lomustine (R-MPL) given as first-line treatment in our center. Fifty-two patients between 2006 and 2019 were included. Eighteen patients proceeded to autologous transplant or two cycles of intermediate-dose cytarabine. The median age was 62 y (range 28–94) and the Eastern Cooperative Oncology Group performance status (ECOG-PS) was ≥2 in 62% (32/52). The overall/complete response rates were 79% (41/52) and 52% (27/52), respectively. The median progression-free/overall survival was 19 m/84m, respectively. Grade 3–4 adverse events included infections (17%) and kidney injury (13%). Ten patients (19%) discontinued therapy for toxicity. There were no treatment-related deaths. In summary, in a cohort enriched in frail patients, R-MPL achieved good responses and OS and was safe for all ages. The PFS was sub-optimal, possibly explained by a low proportion of consolidation. This regimen should be evaluated prospectively.

Original language	English
Pages (from-to)	2102-2108
Number of pages	7
Journal	Leukemia and Lymphoma
Volume	63
Issue number	9
DOIs	https://doi.org/10.1080/10428194.2022.2064996
State	Published - Sep 2022

Bibliographical note

Publisher Copyright:
© 2022 Informa UK Limited, trading as Taylor & Francis Group.

Keywords

Primary CNS lymphoma
lomustine
methotrexate
procarbazine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1080/10428194.2022.2064996

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Lebel, E., Goldschmidt, N., Siegal, T., Lossos, A., Rosenberg, S., Makranz, C., Linetski, E., Gatt, M. E., Gural, A., Saban, R., Lavie, D., Vainstein, V., Zimran, E., Avni, B., Grisaro, S., Shaulov, A., & Nachmias, B. (2022). Rituximab, methotrexate, procarbazine and lomustine (R-MPL) for the treatment of primary Central nervous system lymphoma. Leukemia and Lymphoma, 63(9), 2102-2108. https://doi.org/10.1080/10428194.2022.2064996

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abstract = "The optimal high-dose methotrexate (HDMTX)-based combination therapy for primary central nervous system lymphoma is unknown. We report our experience with rituximab, HDMTX, procarbazine and lomustine (R-MPL) given as first-line treatment in our center. Fifty-two patients between 2006 and 2019 were included. Eighteen patients proceeded to autologous transplant or two cycles of intermediate-dose cytarabine. The median age was 62 y (range 28–94) and the Eastern Cooperative Oncology Group performance status (ECOG-PS) was ≥2 in 62% (32/52). The overall/complete response rates were 79% (41/52) and 52% (27/52), respectively. The median progression-free/overall survival was 19 m/84m, respectively. Grade 3–4 adverse events included infections (17%) and kidney injury (13%). Ten patients (19%) discontinued therapy for toxicity. There were no treatment-related deaths. In summary, in a cohort enriched in frail patients, R-MPL achieved good responses and OS and was safe for all ages. The PFS was sub-optimal, possibly explained by a low proportion of consolidation. This regimen should be evaluated prospectively.",

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Lebel, E, Goldschmidt, N, Siegal, T, Lossos, A, Rosenberg, S, Makranz, C, Linetski, E, Gatt, ME , Gural, A, Saban, R, Lavie, D, Vainstein, V, Zimran, E, Avni, B, Grisaro, S, Shaulov, A & Nachmias, B 2022, 'Rituximab, methotrexate, procarbazine and lomustine (R-MPL) for the treatment of primary Central nervous system lymphoma', Leukemia and Lymphoma, vol. 63, no. 9, pp. 2102-2108. https://doi.org/10.1080/10428194.2022.2064996

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T1 - Rituximab, methotrexate, procarbazine and lomustine (R-MPL) for the treatment of primary Central nervous system lymphoma

AU - Lebel, Eyal

AU - Goldschmidt, Neta

AU - Siegal, Tali

AU - Lossos, Alexander

AU - Rosenberg, Shai

AU - Makranz, Chen

AU - Linetski, Eduard

AU - Gatt, Moshe E.

AU - Gural, Alexander

AU - Saban, Revital

AU - Lavie, David

AU - Vainstein, Vladimir

AU - Zimran, Eran

AU - Avni, Batia

AU - Grisaro, Sigal

AU - Shaulov, Adir

AU - Nachmias, Boaz

PY - 2022/9

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N2 - The optimal high-dose methotrexate (HDMTX)-based combination therapy for primary central nervous system lymphoma is unknown. We report our experience with rituximab, HDMTX, procarbazine and lomustine (R-MPL) given as first-line treatment in our center. Fifty-two patients between 2006 and 2019 were included. Eighteen patients proceeded to autologous transplant or two cycles of intermediate-dose cytarabine. The median age was 62 y (range 28–94) and the Eastern Cooperative Oncology Group performance status (ECOG-PS) was ≥2 in 62% (32/52). The overall/complete response rates were 79% (41/52) and 52% (27/52), respectively. The median progression-free/overall survival was 19 m/84m, respectively. Grade 3–4 adverse events included infections (17%) and kidney injury (13%). Ten patients (19%) discontinued therapy for toxicity. There were no treatment-related deaths. In summary, in a cohort enriched in frail patients, R-MPL achieved good responses and OS and was safe for all ages. The PFS was sub-optimal, possibly explained by a low proportion of consolidation. This regimen should be evaluated prospectively.

AB - The optimal high-dose methotrexate (HDMTX)-based combination therapy for primary central nervous system lymphoma is unknown. We report our experience with rituximab, HDMTX, procarbazine and lomustine (R-MPL) given as first-line treatment in our center. Fifty-two patients between 2006 and 2019 were included. Eighteen patients proceeded to autologous transplant or two cycles of intermediate-dose cytarabine. The median age was 62 y (range 28–94) and the Eastern Cooperative Oncology Group performance status (ECOG-PS) was ≥2 in 62% (32/52). The overall/complete response rates were 79% (41/52) and 52% (27/52), respectively. The median progression-free/overall survival was 19 m/84m, respectively. Grade 3–4 adverse events included infections (17%) and kidney injury (13%). Ten patients (19%) discontinued therapy for toxicity. There were no treatment-related deaths. In summary, in a cohort enriched in frail patients, R-MPL achieved good responses and OS and was safe for all ages. The PFS was sub-optimal, possibly explained by a low proportion of consolidation. This regimen should be evaluated prospectively.

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KW - lomustine

KW - methotrexate

KW - procarbazine

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Rituximab, methotrexate, procarbazine and lomustine (R-MPL) for the treatment of primary Central nervous system lymphoma

Abstract

Bibliographical note

Keywords

UN SDGs

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