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Zhong K, Shi Y, Gao Y, Zhang H, Zhang M, Zhang Q, Cen X, Xue M, Qin Y, Zhao Y, Zhang L, Liang R, Wang N, Xie Y, Yang Y, Liu A, Bao H, Wang J, Cao B, Zhang W, Zhang W. First-line induction chemotherapy with high-dose methotrexate versus teniposide in patients with newly diagnosed primary central nervous system lymphoma: a retrospective, multicenter cohort study. BMC Cancer 2023; 23:746. [PMID: 37568079 PMCID: PMC10416388 DOI: 10.1186/s12885-023-11268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 08/07/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This study aimed to compare the efficacy and safety of high-dose methotrexate (HD-MTX) versus teniposide (TEN) in patients with newly diagnosed immunocompetent primary central nervous system lymphomas (PCNSLs). METHODS The study included immunocompetent, adult patients with newly diagnosed PCNSL at 22 centers in China from 2007 to 2016. The patients received HD-MTX or TEN as first-line induction therapy. The objective response rate, progression-free survival, and overall survival were analyzed for each patient cohort. RESULTS A total of 96 patients were eligible: 62 received HD-MTX, while 34 received teniposide. The overall response rate was 73.2% and 72.7% in the MTX and the TEN cohorts, respectively (P = 0.627). The median progression-free survival was 28.4 months [95% confidence interval (CI): 13.7-51.2] in the MTX cohort and 24.3 months (95% CI: 16.6-32.1) in the TEN cohort (P = 0.75). The median overall survival was 31 months (95% CI: 26.8-35.2) in the MTX cohort and 32 months (95% CI: 27.6-36.4) in the TEN cohort (P = 0.77). The incidence of any grade of coagulopathy/deep-vein thrombosis and gastrointestinal disorders was significantly higher in the MTX cohort than in the TEN cohort; no significant difference was found in the incidence of other adverse events between the two cohorts. CONCLUSIONS This was the first multicenter study using TEN as the main agent compared with HD-MTX in newly diagnosed primary CNS lymphoma. The TEN-based regimen was non-inferior to the HD-MTX-based regimen with similar overall responses. CLASSIFICATION OF EVIDENCE This study provided Class III evidence that the teniposide-based regimen was non-inferior to high-dose methotrexate - based regimen with similar overall responses and long-time survival in immunocompetent patients with PCNSL.
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Affiliation(s)
- Kaili Zhong
- Department of Lymphoma, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Yanyan Shi
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yuhuan Gao
- Department of Hematology, Fourth Hospital of Hebei Medical University (Tumor Hospital of Hebei Province), Shijiazhuang, China
| | - Huilai Zhang
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiaohua Zhang
- Department of Oncology, Shanxi Academy of Medical Sciences & Shanxi Bethune Hospital, Shanxi Bethune Hospital affiliated to Shanxi Medical University, Taiyuan, China
| | - Xinan Cen
- Department of Hematology, Peking University First Hospital, Beijing, China
| | - Mei Xue
- Department of Hematology, Air Force Medical Center, Beijing, China
| | - Yan Qin
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Zhao
- Department of Hematology, the General Hospital of PLA, Beijing, China
| | - Liling Zhang
- Department of Lymphoma, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Liang
- Department of Hematology, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Ningju Wang
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yan Xie
- Departments of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yu Yang
- Department of Medical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Aichun Liu
- Department of Hematology and Lymphoma, Cancer hospital of Harbin Medical University, Haerbin, China
| | - Huizheng Bao
- Department of Medical Oncology, Jilin Cancer Hospital, Changchun, China
| | - Jingwen Wang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Baoping Cao
- Department of Lymphoma, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Weijing Zhang
- Department of Lymphoma, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
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