Brain Tumor Res Treat.  2015 Oct;3(2):75-80. 10.14791/btrt.2015.3.2.75.

Efficacy of Procarbazine, Lomustine, and Vincristine Chemotherapy for Recurrent Primary Central Nervous System Lymphomas

• Kim YJ
• Choe JH
• Park JH
• Hong YK

• KMID: 2114651
• DOI: http://doi.org/10.14791/btrt.2015.3.2.75

Abstract

BACKGROUND
Optimal treatment for recurrent primary central nervous system lymphomas (PCNSLs) has not been defined yet and there is no general consensus about the salvage chemotherapy after high-dose methotrexate (HD-MTX)-based chemotherapy. The purpose of the present study was to evaluate the efficacy and safety of procarbazine, lomustine, and vincristine (PCV) chemotherapy for recurrent PCNSLs.
METHODS
We reviewed eight immunocompetent patients (five males/three females, mean age: 56 years) who received salvage PCV chemotherapy (procarbazine 60 mg/m2, days 8 through 21: CCNU 110 mg/m2, day 1: vincristine 2 mg, days 8 and 28) for recurrent PCNSL and two patients switched to PCV chemotherapy due to severe adverse effects of HD-MTX chemotherapy. Radiologic responses, survival, and adverse effects were analyzed.
RESULTS
Of the eight recurrent PCNSLs, three patients (37.5%) showed radiologic complete response, one patient (12.5%) showed partial response, and four patients (50%) showed progressive disease after PCV chemotherapy. Median progression free survival (PFS) from the first administration of PCV to relapse or last follow-up was 7 months (range 5-32 months) and median overall survival was 8 months (range 2-41 months). The two patients who switched to PCV chemotherapy showed PFS of 9 and 5 months from the beginning of PCV to relapse. The common side effects were thrombocytopenia, neutropenia, and peripheral neuropathy. There were 4 grade III or IV myelo-suppression, but no fatal complications, including severe hemorrhage or infection, were observed.
CONCLUSION
Salvage PCV chemotherapy has a moderate anti-lymphoma activity for recurrent PCNSLs after the HD-MTX-based chemotherapy with tolerable toxicity.

Keyword

Lymphoma; Central nervous system; Salvage therapy; Chemotherapy; Methotrexate

MeSH Terms

Central Nervous System*
Consensus
Disease-Free Survival
Drug Therapy*
Female
Follow-Up Studies
Hemorrhage
Humans
Lomustine*
Lymphoma*
Methotrexate
Neutropenia
Peripheral Nervous System Diseases
Procarbazine*
Recurrence
Salvage Therapy
Thrombocytopenia
Vincristine*
Lomustine
Methotrexate
Procarbazine
Vincristine

Figure

• 

  Fig. 1 Treatment strategy for recurrent or relapsed PCNSLs. HD-MTX, high dose methotrexate; PCNSLs, primary central nervous system lymphomas; PCV, procarbazine, lomustine, and vincristine; reMTX, re-challenging of HD-MTX monotherapy.

• 

  Fig. 2 Cumulative overall survival according to response to PCV chemotherapy. PCV, procarbazine, lomustine, and vincristine.

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