Older Patients with Primary Central Nervous System Lymphoma: Survival and Prognostication Across 20 US Cancer Centers.

There is a paucity of large-scale data delineating outcomes and prognostication of older patients with primary central nervous system lymphoma (PCNSL). We retrospectively analyzed 539 newly-diagnosed PCNSL patients ages ≥60 years across 20 US academic centers. Median age was 70 years (range 60-88); at least one geriatric syndrome was present in 46%; median Cumulative Index Ratings Scale-Geriatrics (CIRS-G) score was 6 (range 0-27); and 36% had impairment in at least one activities of daily living (ADL). The most common induction regimens were high-dose methotrexate +/- rituximab; methotrexate, temozolomide, rituximab (MTR); and rituximab, methotrexate, procarbazine, vincristine (R-MPV). Overall, 70% of patients achieved remission with 14% undergoing consolidative autologous stem cell transplant (ASCT), and 24% receiving maintenance. With 58-month median follow-up, median progression-free survival (PFS) and overall survival (OS) were 17 months (95% CI 13-22 months) and 43 months (95% CI 31-56 months), respectively. Three-year PFS and OS were highest with MTR (55% and 74%, respectively). Wiith single-agent methotrexate +/- rituximab, 3-year PFS and OS were 30% (p=.0002) and 47% (p=.0072), respectively. On multivariate analysis, increasing age at diagnosis and ECOG performance status (PS) were associated with inferior PFS, and age, hypoalbuminemia, higher CIRS-G score, and ECOG PS adversely affected OS. Among patients receiving maintenance, 3-year PFS was 65% versus 45% without maintenance (P=0.02), with 3-year OS of 84% vs. 61%, respectively (P=.0003). Altogether, outcomes in older PCNSL patients appeared optimized with high-dose methotrexate combination induction as well as maintenance. Furthermore, several prognostic factors, including geriatric measures, were associated with divergent outcomes. This article is protected by copyright. All rights reserved.