Data from: Management and outcome of primary CNS lymphoma patients in the modern era. a LOC network study

Objective: Studies on primary CNS lymphoma (PCNSL) patients in the “real
life” are scarce. Our objective was to analyze, in a nationwide
population-based study, the current medical practice in the management of
PCNSL. Methods: The LOC database prospectively records all newly diagnosed
PCNSL from 32 French centers. Data of patients diagnosed between 2011-2016
were retrospectively analyzed. Results: We identified 1002 immunocompetent
patients (43% aged>70 years, median KPS 60). First-line treatment
was high-dose methotrexate-based chemotherapy in 92% of cases, with an
increasing use of rituximab over time (66%). Patients <60 years old
received consolidation treatment in 77% of cases, consisting of
whole-brain radiotherapy (WBRT) (54%) or high-dose chemotherapy with
autologous stem cell transplantation (HCT-ASCT) (23%). Among the patients
> 60 years old, WBRT and HCT-ASCT consolidation were administered
in only 9% and 2%, respectively. The complete response rate to initial
chemotherapy was 50%. Median progression-free survival was 10.5 months.
For relapse, second-line chemotherapy, HCT-ASCT, WBRT and palliative care
were offered to 55%, 17%, 10%, and 18% of patients, respectively. The
median, 2-year and 5-year overall survival was 25.3 months, 51% and 38%,
respectively (< 60 years: not reached (NR), 70% and 61%; >
60 years: 15.4 months, 44% and 28%). Age, KPS, sex and response to
induction CT were independent prognostic factors in multivariate analysis.
Conclusions: Our study confirms the increasing proportion of elderly
within PCNSL and shows comparable outcome in this population-based study
with those reported by clinical trials, reflecting a notable application
of recent PCNSL advances in the real life.

研究背景：针对原发性中枢神经系统淋巴瘤（primary CNS lymphoma, PCNSL）患者的真实世界研究尚且匮乏。本研究旨在通过一项全国性基于人群的队列研究，分析当前原发性中枢神经系统淋巴瘤的临床诊疗实践现状。
研究方法：LOC数据库前瞻性收录了法国32个医疗中心的所有新发原发性中枢神经系统淋巴瘤病例。本研究回顾性分析了2011年至2016年间确诊的患者临床数据。
研究结果：本研究共纳入1002例免疫功能正常的原发性中枢神经系统淋巴瘤患者，其中43%的患者年龄＞70岁，中位卡氏功能状态评分（Karnofsky Performance Status, KPS）为60分。92%的患者一线治疗采用以大剂量甲氨蝶呤为基础的化疗方案，利妥昔单抗的使用比例随时间推移逐步升高（达66%）。年龄＜60岁的患者中，77%接受了巩固治疗，其中54%采用全脑放疗（whole-brain radiotherapy, WBRT），23%采用自体造血干细胞移植联合大剂量化疗（high-dose chemotherapy with autologous stem cell transplantation, HCT-ASCT）方案。而年龄＞60岁的患者中，仅9%接受全脑放疗巩固治疗，接受自体造血干细胞移植联合大剂量化疗者仅占2%。初始化疗的完全缓解率为50%，中位无进展生存期为10.5个月。复发患者中，分别有55%、17%、10%和18%的患者接受了二线化疗、自体造血干细胞移植联合大剂量化疗、全脑放疗及姑息治疗。中位总生存期为25.3个月，2年和5年总生存率分别为51%和38%；其中年龄＜60岁患者的中位总生存期未达到（not reached, NR），2年和5年总生存率分别为70%和61%；年龄＞60岁患者的中位总生存期为15.4个月，2年和5年总生存率分别为44%和28%。多因素分析显示，年龄、卡氏功能状态评分、性别及诱导化疗应答情况均为独立预后因素。
研究结论：本研究证实原发性中枢神经系统淋巴瘤患者中老年群体占比逐年升高，且本基于人群的队列研究所得的患者预后数据与临床试验报道结果相当，反映出近年来原发性中枢神经系统淋巴瘤诊疗领域的进展已在真实世界临床实践中得到了较为广泛的应用。