Elderly patients with primary CNS lymphoma have lower response rate and higher mortality on HD-MTX

   Elderly patients (>/=70) with primary central nervous system lymphoma (PCNSL) have a lower response rate and higher mortality on HD-MTX-based chemotherapy compared with younger patients. Their progression-free survival (PFS) is shorter and they receive less salvage therapy which may contribute to the poor prognosis. 

   Those were among the conclusions reached by researchers at University Hospital Zurich in Switzerland and other institutions. Of all the 526 eligible patients, 126 (24%) were aged >/=70. Among them, the rate of complete and partial responses (CR+PR) to HD-MTX-based chemotherapy was 44% in the compared with 57% in the younger patients (P=0.016). A higher rate of grade III/IV leukopenia was observed in the elderly (34% vs 21%, P=0.007). 

   Death on therapy was more frequent (18% vs 11%; P=0.027) in these patients. In contrast, there was no other major age-dependent toxicity. Survival analyses revealed shorter PFS (4.0 vs 7.7 months, P=0.014) and overall survival (OS) (12.5 vs 26.2 months, P <0.001) in the elderly population. The PFS of CR patients was 35.0 months in younger patients compared with 16.1 in the elderly (P=0.024). Additionally, salvage therapy was used less commonly in elderly patients.