What is the prognosis of primary central nervous system lymphoma (PCNSL) in elderly patients?

Updated: Jan 19, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Roth et al found, in a large cohort of 526 PCNSL patients, about 126 who were ≥70 years old. The success with high-dose methotrexate-based chemotherapy was 44% in the elderly versus 57% in the younger patients. The risk of severe leukopenia was greater in the older patients, and the risk of death while on chemotherapy was also greater in this cohort. Progression-free survival was 4.0 months in the elderly compared to 7.7 months in the younger group. Overall survival was shorter, 12.5 months in the elderly group, contrasting with 26.5 months in younger patients. Lastly, older patients were less likely to undergo salvage therapy with whole brain radiation or cytarabine chemotherapy.

Based on their observations, the authors postulate that PCNSL in older patients is a biologically different tumor that is typically more resistant to treatment. The authors discuss possible treatment strategies to be developed in older patients who achieved a complete remission initially.

The awareness of a different prognosis in different age groups is a significant contribution. The possible benefit of newly developed agents may also identify better treatments for the older PCNSL patient. [18]


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