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Age-adapted induction followed by high-dose chemoimmunotherapy and autologous stem cell transplant (ASCT) has shown promise for treating elderly, fit patients with primary central nervous system lymphoma (PCNSL), according to a presentation at the 2022 ASH Annual Meeting.
The regimen is “highly effective” in this patient population and produced survival outcomes similar to those observed in younger patients, according to study presenter Elisabeth Schorb, MD, of the University of Freiburg in Germany.
These results come from the phase 2 MARTA trial, which enrolled 51 patients with newly diagnosed PCNSL who were eligible for intensive treatment. The median age was 72 years (range, 65-80), 53% of patients were women, 65% had multiple lesions, 19.5% had cerebrospinal fluid involvement, and 9% had intraocular involvement.
The patients received 2 cycles of induction with rituximab at 375 mg/m2 on days 0 and 4, methotrexate at 3.5 g/m2 on day 1, and cytarabine at 2 g/m2 twice daily on days 2 and 3 every 3 weeks. Between induction cycles, stem cells were harvested. Consolidation consisted of rituximab at 375 mg/m2 on day -8, busulfan at 3.2 mg/kg on days -7 and -6, and thiotepa at 5 mg/kg on days -5 and -4.
After induction, 11.8% of patients had a complete response (CR), 68.6% had a partial response (PR), 2% had stable disease, and 3.9% had progressive disease. The remaining 13.7% of patients did not complete induction.
A total of 36 patients underwent ASCT. At 30 days post-transplant, 63.9% of patients had a CR and 33.3% had a PR.
During follow-up, 8 patients with an initial PR converted to CR with no additional treatment, 2 converted to CR with off-study treatment, 1 had disease progression without additional treatment, and 1 had disease progression with off-study treatment.
In the intention-to-treat population, the median progression-free survival (PFS) and overall survival (OS) were both 41 months. At 12 months, the PFS rate was 58.8%, and the OS rate was 62.7%.
In the per-protocol population, the median PFS and median OS were 39.4 months. The 12-month PFS rate was 77.8%, and the 12-month OS rate was 80.6%.
The most common adverse events were thrombocytopenia, anemia, febrile neutropenia, and infections.
There were 12 deaths during induction and 10 during consolidation. Deaths were due to relapsed/refractory PCNSL (n=8), infection (n=7), cerebrovascular events (n=3), secondary malignancy (n=1), cardiac events (n=1), lower gastrointestinal bleeding (n=1), and sudden death (n=1).
Dr Schorb noted that survival in this trial is “remarkably better” than survival results seen in any other prospective, multicenter study of elderly PCNSL patients. The outcomes of patients who underwent ASCT in this trial are similar to outcomes typically observed in younger patients, she added.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Schorb E, Isbell L, Kerkhoff A, et al. High-dose chemotherapy and autologous stem cell transplant in elderly and fit primary CNS lymphoma patients – a multicenter study by the Cooperative PCNSL study group (MARTA study). Presented at ASH 2022. December 10-13, 2022. Abstract 736.
This article originally appeared on Cancer Therapy Advisor
