Scientific publications

Diagnostic delay and outcome in immunocompetent patients with primary central nervous system lymphoma in Spain: a multicentric study

Jul 1, 2020 | Magazine: Journal of Neurooncology

R Velasco  1   2   3 , S Mercadal  4 , N Vidal  5   6 , M Alañá  7 , M I Barceló  8 , M J Ibáñez-Juliá  9 , S Bobillo  10 , R Caldú Agud  11 , E García Molina  12 , P Martínez  13 , P Cacabelos  14 , A Muntañola  15 , G García-Catalán  16 , J M Sancho  17 , I Camro  18 , T Lado  19 , M E Erro  20 , L Gómez-Vicente  21 , A Salar  22 , A C Caballero  23 , M Solé-Rodríguez  24 , J Gállego Pérez-Larraya  25 , N Huertas  26 , J Estela  27 , M Barón  28 , N Barbero-Bordallo  29 , M Encuentra  4 , I Dlouhy  30 , J Bruna  5   31 , F Graus  30 , GELTAMO and GENOSEN group


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.

CITA DEL ARTÍCULO  J Neurooncol. 2020 Jul;148(3):545-554. doi: 10.1007/s11060-020-03547-z. Epub 2020 Jun 10

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