OS7.6 Management patterns and outcome of patients with primary CNS lymphoma (PCNSL) in France during 2011–2016. A LOC network study

Abstract

Background: The current standard of care of PCNSL patients is still matter of debates. Methods: To overview the practices in France, clinical and treatment characteristics of PCNSL patients diagnosed from 2011 to 2016 within the LOC network were analyzed. The LOC database records prospectively all newly diagnosed PCNSL in the 22 regional expert centers for PCNSL covering the whole country and certified by the national cancer institute (INCa). Results: Data from 971 patients were available in the LOC database: sex ratio: 1.05, median age: 67 (18-92), median Karnofsky Performance Status: 60 (20-100), diffuse large B cell lymphoma: 97%, ocular involvement: 20%, CSF dissemination: 18%. Diagnosis procedure was biopsy (80%), tumor resection (9%), vitrectomy (8%), CSF cytology (3%). Therapeutic options were discussed in national multidisciplinary webconferences twice a month, according to national guidelines (200 to 300 cases each year). Treatment was initiated either by a neurooncology or a haematology team in 38% and 62%, respectively. Median delay between first symptoms and onset of treatment was 62 days. First line treatment was high-dose (hd) methotrexate (MTX) based chemotherapy (CT) in 90% of cases (combined with hd cytarabine in 67% and rituximab in 58% of cases), other chemotherapy regimen in 6%, and palliative care in 4% of cases. Patients < 60 years (n=277) received a consolidation treatment in 54 % of cases consisting of whole brain radiotherapy (WBRT) (36%) or hd CT with autologous stem cell transplantation (hd CT-ASCT) (18%). In patients > 60 years (n=694), WBRT and hd CT-ASCT as consolidation were given in only 5% and 1%, respectively. 16% of patients were included in prospective trials. Response rates to initial treatment among evaluable patients were: complete response: 59%; partial response: 10%; stable disease: 3%; progressive disease: 28%. Median progression free survival (PFS) was 9.9 months (< 60 years: 34.6 months; > 60 years: 7.9 months). At relapse, second line chemotherapy, hd CT-ASCT, WBRT and palliative care were offered in 50%, 18%, 12%, 20% of patients respectively. Median overall survival (OS) and 5-year OS were respectively 30 months and 41% (< 60 years: not reached, 68%; > 60 years: 15 months, 30%). Conclusion: The therapeutic practices in France reflect the current knowledge and controversies in PCNSL. Elderly patients account for more than 70% of PCNSL. Hd MTX and cytarabine are largely used in first line CT regimen. Consolidation WBRT has almost disappeared in the elderly and is still offered in one third of the younger patients. The use of Rituximab and hd CT-ASCT is increasing over time. Long term survival has become frequent, especially among youngest patients. On behalf of the French LOC network.