Scientific publications
Diagnostic delay and outcome in immunocompetent patients with primary central nervous system lymphoma in Spain: a multicentric study
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.
CITATION J Neurooncol. 2020 Jul;148(3):545-554. doi: 10.1007/s11060-020-03547-z. Epub 2020 Jun 10
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