Background/Objectives:Short induction followed by high-dose chemotherapy and autologous stem cell transplantation (HCT-ASCT) is effective in newly diagnosed elderly patients with primary central nervous system lymphoma (PCNSL) but associated with significant toxicity. Geriatric assessments (GAs) may help to predict treatment risk and prognosis, yet no standardized GAs exist for PCNSL. Our aim was to evaluate the impact of GA on HCT-ASCT eligibility and survival.Methods:We analyzed 65 patients > 65 years treated in the MARiTA and MARTA studies. Treatment comprised 2 cycles of rituximab, HD-MTX and cytarabine followed by HCT-ASCT. GAs at diagnosis were analyzed for progression-free survival (PFS), overall survival (OS) and premature end of treatment (pEOT).Results:After median follow-up of 43 months, 12-month PFS/OS were 69.2% (95% CI 56.5–78.9%)/70.8% (58.1–80.2%) from diagnosis and 80.4% (66.6–88.9%)/84.3% (71.1–91.8%) from time of HCT-ASCT. ECOG PS ≥ 2, Lachs geriatric screening (Lachs) ≥30% and Cumulative Illness Rating Scale-Geriatric (CIRS-G) ≥6, ≥7 and ≥8, respectively, were significantly associated with pEOT in univariate analysis (UVA). In multivariate analysis (MVA), CIRS-G remained significant. A composite EBL score (ECOG PS ≥ 2, Barthel Index of Activities of Daily Living (Barthel) < 20, Lachs ≥ 30%) ≤1 predicted successful completion of HCT-ASCT in >90% of patients. ECOG PS ≥ 2 and Barthel < 20 were associated with decreased PFS and OS in UVA; ECOG PS ≥ 2 remained significant in MVA.Conclusions:This is the first study to link GA with treatment feasibility in elderly PCNSL patients undergoing intensive therapy. Our results will be validated in the PRIMA-CNS trial (EudraCT 2020-001181-10).
背景/目的：短期诱导后接续大剂量化疗联合自体干细胞移植（HCT-ASCT）对初诊老年原发性中枢神经系统淋巴瘤（PCNSL）患者有效，但存在显著毒性。老年综合评估（GA）可能有助于预测治疗风险及预后，但目前PCNSL领域尚无标准化GA方案。本研究旨在评估GA对HCT-ASCT适用性及生存结局的影响。 方法：我们分析了MARiTA与MARTA研究中65例年龄＞65岁的患者。治疗方案为2个周期的利妥昔单抗、大剂量甲氨蝶呤及阿糖胞苷诱导后行HCT-ASCT。通过诊断时的GA指标分析无进展生存期（PFS）、总生存期（OS）及治疗提前终止（pEOT）情况。 结果：中位随访43个月后，从诊断起算的12个月PFS/OS分别为69.2%（95% CI 56.5–78.9%）/70.8%（58.1–80.2%），从HCT-ASCT起算则分别为80.4%（66.6–88.9%）/84.3%（71.1–91.8%）。单因素分析显示，ECOG体能状态评分≥2分、Lachs老年筛查评分≥30%以及老年累积疾病评定量表（CIRS-G）评分分别≥6、≥7、≥8分与pEOT显著相关。多因素分析中CIRS-G仍保持显著性。综合EBL评分（ECOG≥2分、Barthel日常生活活动指数<20分、Lachs≥30%）≤1分可预测＞90%患者能成功完成HCT-ASCT。单因素分析中ECOG≥2分与Barthel<20分与PFS及OS降低相关；多因素分析中ECOG≥2分仍具显著性。 结论：本研究首次将GA与接受强化治疗的老年PCNSL患者的治疗可行性相关联。相关结果将在PRIMA-CNS试验（EudraCT 2020-001181-10）中进行验证。
肿瘤(癌症)患者之家