R Velasco1,2,3, S Mercadal4, F Graus5, N Vidal6,7, M Alañá8, M I Barceló9, M J Ibáñez-Juliá10, S Bobillo11, R Caldú Agud12, E García Molina13, P Martínez14, P Cacabelos15, A Muntañola16, G García-Catalán17, J M Sancho18, I Camro19, T Lado20, M E Erro21, L Gómez-Vicente22, A Salar23, A C Caballero24, M Solé-Rodríguez25, J Gállego Pérez-Larraya26, N Huertas27, J Estela28, M Barón29, N Barbero-Bordallo30, M Encuentra4, I Dlouhy5, J Bruna6,31. 1. Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. rvelascof@bellvitgehospital.cat. 2. Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain. rvelascof@bellvitgehospital.cat. 3. Department of Neurology, Neuro-Oncology Unit, Hospital Universitari de Bellvitge and ICO L'Hospitalet, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain. rvelascof@bellvitgehospital.cat. 4. Department of Hematology, Catalan Institute of Oncology-Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 5. Department of Hematology and Neurology, Hospital Clínic de Barcelona, Barcelona, Spain. 6. Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. 7. Department of Pathology, Unit of Neuro-Oncology. Hospital Universitari de Bellvitge-ICO Duran i Reynals, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain. 8. Department of Neurology, Complejo Asistencial Universitario, Salamanca, Spain. 9. Department of Neurology, Hospital Universitario Son Espases, Palma de Mallorca, Spain. 10. Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain. 11. Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), University Hospital Vall d'Hebron, Barcelona, Spain. 12. Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain. 13. Department of Neurology, Virgen de la Arrixaca University Hospital, Murcia, Spain. 14. Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain. 15. Department of Neurology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain. 16. Department of Hematology, Hospital Universitario Mutua de Terrassa, Terrassa, Spain. 17. Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain. 18. Department of Hematology, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Spain. 19. Department of Neurology, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain. 20. Department of Hematology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. 21. Neurology Department, Complejo Hospitalario de Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain. 22. Department of Neurology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid, Spain. 23. Department of Hematology, Hospital del Mar, Barcelona, Spain. 24. Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 25. Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla, Spain. 26. Departament of Neurology, Clínica Universidad de Navarra, IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain. 27. Department of Neurology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain. 28. Department of Neurology, Hospital Parc Taulí, Sabadell, Spain. 29. Unit of Neurology, Hospital Universitario Fundación Alcorcón, Madrid, Spain. 30. Department of Neurology, Hospital Universitario Rey Juan Carlos, HURJC-HUIE-HCV, Madrid, Spain. 31. Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain.
Abstract
INTRODUCTION: To assess the management of immunocompetent patients with primary central nervous system lymphomas (PCNSL) in Spain. METHODS: Retrospective analysis of 327 immunocompetent patients with histologically confirmed PCNSL diagnosed between 2005 and 2014 in 27 Spanish hospitals. RESULTS: Median age was 64 years (range: 19-84; 33% ≥ 70 years), 54% were men, and 59% had a performance status (PS) ≥ 2 at diagnosis. Median delay to diagnosis was 47 days (IQR 24-81). Diagnostic delay > 47 days was associated with PS ≥ 2 (OR 1.99; 95% CI 1.13-3.50; p = 0.016) and treatment with corticosteroids (OR 2.47; 95% CI 1.14-5.40; p = 0.023), and it did not improve over the years. Patients treated with corticosteroids (62%) had a higher risk of additional biopsies (11.7% vs 4.0%, p = 0.04) but corticosteroids withdrawal before surgery did not reduce this risk and increased the diagnostic delay (64 vs 40 days, p = 0.04). Median overall survival (OS) was 8.9 months [95% CI 5.9-11.7] for the whole series, including 52 (16%) patients that were not treated, and 14.1 months (95%CI 7.7-20.5) for the 240 (73.4%) patients that received high-dose methotrexate (HD-MTX)-based chemotherapy. Median OS was shorter in patients ≥ 70 years (4.1 vs. 13.4 months; p < 0.0001). Multivariate analysis identified age ≥ 65 years, PS ≥ 2, no treatment, and cognitive/psychiatric symptoms at diagnosis as independent predictors of short survival. CONCLUSIONS: Corticosteroids withdrawal before surgery does not decrease the risk of a negative biopsy but delays diagnosis. In this community-based study, only 73.4% of patients could receive HD-MTX-based chemotherapy and OS remains poor, particularly in elderly patients ≥ 70 years.
INTRODUCTION: To assess the management of immunocompetent patients with primary central nervous system lymphomas (PCNSL) in Spain. METHODS: Retrospective analysis of 327 immunocompetent patients with histologically confirmed PCNSL diagnosed between 2005 and 2014 in 27 Spanish hospitals. RESULTS: Median age was 64 years (range: 19-84; 33% ≥ 70 years), 54% were men, and 59% had a performance status (PS) ≥ 2 at diagnosis. Median delay to diagnosis was 47 days (IQR 24-81). Diagnostic delay > 47 days was associated with PS ≥ 2 (OR 1.99; 95% CI 1.13-3.50; p = 0.016) and treatment with corticosteroids (OR 2.47; 95% CI 1.14-5.40; p = 0.023), and it did not improve over the years. Patients treated with corticosteroids (62%) had a higher risk of additional biopsies (11.7% vs 4.0%, p = 0.04) but corticosteroids withdrawal before surgery did not reduce this risk and increased the diagnostic delay (64 vs 40 days, p = 0.04). Median overall survival (OS) was 8.9 months [95% CI 5.9-11.7] for the whole series, including 52 (16%) patients that were not treated, and 14.1 months (95%CI 7.7-20.5) for the 240 (73.4%) patients that received high-dose methotrexate (HD-MTX)-based chemotherapy. Median OS was shorter in patients ≥ 70 years (4.1 vs. 13.4 months; p < 0.0001). Multivariate analysis identified age ≥ 65 years, PS ≥ 2, no treatment, and cognitive/psychiatric symptoms at diagnosis as independent predictors of short survival. CONCLUSIONS: Corticosteroids withdrawal before surgery does not decrease the risk of a negative biopsy but delays diagnosis. In this community-based study, only 73.4% of patients could receive HD-MTX-based chemotherapy and OS remains poor, particularly in elderly patients ≥ 70 years.
Entities:
Keywords:
Diagnostic delay; Outcome; Primary central nervous system lymphoma; Prognostic factors; Steroids
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