CHOD/BVAM chemotherapy and whole-brain radiotherapy for newly diagnosed primary central nervous system lymphoma

Nadia N Laack, Brian Patrick O'Neill, Karla V Ballman, Judith Rich O'Fallon, Xiomara W Carrero, Paul J Kurtin, Bernd W Scheithauer, Paul D Brown, Thomas M Habermann, Joseph P Colgan, Mark R Gilbert, Roland B Hawkins, Roscoe F Morton, Harry E Windschitl, Tom R Fitch, Eduardo R Pajon Jr, North Central Cancer Treatment Group and Mayo Clinic, Daniel A Nikcevich, Kendrith M Rowland, Martin Wiesenfeld, Tudor Dentchev, Loren K Tschetter, Sioux Falls, Paul L Schaefer, Gamini S Soori, Shaker R Dakhil, Patrick J Flynn, Nadia N Laack, Brian Patrick O'Neill, Karla V Ballman, Judith Rich O'Fallon, Xiomara W Carrero, Paul J Kurtin, Bernd W Scheithauer, Paul D Brown, Thomas M Habermann, Joseph P Colgan, Mark R Gilbert, Roland B Hawkins, Roscoe F Morton, Harry E Windschitl, Tom R Fitch, Eduardo R Pajon Jr, North Central Cancer Treatment Group and Mayo Clinic, Daniel A Nikcevich, Kendrith M Rowland, Martin Wiesenfeld, Tudor Dentchev, Loren K Tschetter, Sioux Falls, Paul L Schaefer, Gamini S Soori, Shaker R Dakhil, Patrick J Flynn

Abstract

Purpose: To assess the efficacy and toxicity of chemotherapy consisting of cyclophosphamide, doxorubicin (Adriamycin), vincristine, and dexamethasone (CHOD) plus bis-chloronitrosourea (BCNU), cytosine arabinoside, and methotrexate (BVAM) followed by whole-brain irradiation (WBRT) for patients with primary central nervous system lymphoma (PCNSL).

Methods and materials: Patients 70 years old and younger with newly diagnosed, biopsy-proven PCNSL received one cycle of CHOD followed by two cycles of BVAM. Patients then received WBRT, 30.6 Gy, if a complete response was evoked, or 50.4 Gy if the response was less than complete; both doses were given in 1.8-Gy daily fractions. The primary efficacy endpoint was 1-year survival.

Results: Thirty-six patients (19 men, 17 women) enrolled between 1995 and 2000. Median age was 60.5 years (range, 34 to 69 years). Thirty (83%) patients had baseline Eastern Cooperative Oncology Group performance scores of 0 to 1. All 36 patients were eligible for survival and response evaluations. Median time to progression was 12.3 months, and median survival was 18.5 months. The percentages of patients alive at 1, 2, and 3 years were 64%, 36%, and 33%, respectively. The best response was complete response in 10 patients and immediate progression in 7 patients. Ten (28%) patients had at least one grade 3 or higher neurologic toxicity.

Conclusions: This regimen did improve the survival of PCNSL patients but also caused substantial toxicity. The improvement in survival is less than that reported with high-dose methotrexate-based therapies.