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Impact of maintenance rituximab on duration of response in primary central nervous system lymphoma

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Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

The role of maintenance immunotherapy with anti-CD20 monoclonal antibody rituximab in primary central nervous system lymphoma (PCNSL) is unclear. We retrospectively reviewed the medical records of all immunocompetent adults with newly diagnosed PCNSL treated at our institution between1996 and 2017.

Methods

We identified 66 patients who attained complete response (CR) after completion of first-line regimen; 20 received maintenance therapy (maintenance therapy group) and 46 were observed with serial MRI scans without maintenance therapy (no-maintenance therapy group).

Results

Compared to the surveillance group, there was a significant increase in duration of survival (HR 0.27, 95% CI 0.08–0.98, P = 0.046) in the maintenance therapy group while the reduction in the risk of progression was not significant (HR: 0.61, 95% CI 0.26–1.43, P = 0.259).

Conclusion

We are evaluating the effectiveness of maintenance immunotherapy in PCNSL in a prospective multicenter randomized clinical trial.

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References

  1. Abrey LE, Batchelor TT, Ferreri AJ et al (2005) (2005) Report of an international workshop to standardize baseline evaluation and response criteria for primary CNS lymphoma. J Clin Oncol. 23(22):5034–5043

    Article  Google Scholar 

  2. Grommes C, DeAngelis LM (2017) Primary CNS lymphoma. J Clin Oncol 35(21):2410–2418

    Article  CAS  Google Scholar 

  3. Neuwelt EA, Schiff D (2015) Primary CNS lymphoma: a landmark trial and the next steps. Neurology 84(12):1194–1195

    Article  Google Scholar 

  4. Ambady P, Holdhoff M, Bonekamp D et al (2015) Late relapses in primary CNS lymphoma after complete remissions with high-dose methotrexate monotherapy. CNS Oncol 4(6):393–398

    Article  CAS  Google Scholar 

  5. Jahnke K, Thiel E, Martus P et al (2006) Relapse of primary central nervous system lymphoma: clinical features, outcome and prognostic factors. J Neurooncol 80(2):159–165

    Article  Google Scholar 

  6. Hochster H, Weller E, Gascoyne RD et al (2009) Maintenance rituximab after cyclophosphamide, vincristine, and prednisone prolongs progression-free survival in advanced indolent lymphoma: results of the randomized phase III ECOG1496 Study. J Clin Oncol 27(10):1607–1614

    Article  CAS  Google Scholar 

  7. Salles G, Seymour JF, Offner F et al (2011) Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial. Lancet 377(9759):42–51

    Article  CAS  Google Scholar 

  8. Sehn LH, Assouline SE, Stewart DA et al (2012) A phase 1 study of obinutuzumab induction followed by 2 years of maintenance in patients with relapsed CD20-positive B-cell malignancies. Blood 119(22):5118–5125

    Article  CAS  Google Scholar 

  9. Ney DE, Abrey LE (2009) Maintenance therapy for central nervous system lymphoma with rituximab. Leuk Lymphoma 50(9):1548–1551

    Article  CAS  Google Scholar 

  10. Angelov L, Doolittle ND, Kraemer DF et al (2009) Blood-brain barrier disruption and intra-arterial methotrexate-based therapy for newly diagnosed primary CNS lymphoma: a multi-institutional experience. J Clin Oncol 27(21): 3503–3509

  11. Neuwelt EA, Goldman DL, Dahlborg SA et al (1991) Primary CNS lymphoma treated with osmotic blood-brain barrier disruption: prolonged survival and preservation of cognitive function. J Clin Oncol 9(9):1580–1590

    Article  CAS  Google Scholar 

  12. Doolittle ND, Miner ME, Hall WA et al (2000) Safety and efficacy of a multicenter study using intraarterial chemotherapy in conjunction with osmotic opening of the blood-brain barrier for the treatment of patients with malignant brain tumors. Cancer 88(3):637–647

    Article  CAS  Google Scholar 

  13. McAllister LD, Doolittle ND, Guastadisegni PE et al (2000) Cognitive outcomes and long-term follow-up results after enhanced chemotherapy delivery for primary central nervous system lymphoma. Neurosurgery 46(1):51–60 discussion 60–51

    Article  CAS  Google Scholar 

  14. Holdhoff M, Ambady P, Abdelaziz A et al (2014) High-dose methotrexate with or without rituximab in newly diagnosed primary CNS lymphoma. Neurology 83(3):235–239

    Article  CAS  Google Scholar 

  15. Ferreri AJ, Cwynarski K, Pulczynski E et al (2016) Chemoimmunotherapy with methotrexate, cytarabine, thiotepa, and rituximab (MATRix regimen) in patients with primary CNS lymphoma: results of the first randomisation of the International Extranodal Lymphoma Study Group-32 (IELSG32) phase 2 trial. Lancet Haematol 3(5):e217-227

    Article  Google Scholar 

  16. Doolittle N, Kraemer D, Lacy C et al (2010) Enhanced delivery of rituximab in combination with methotrexate-based blood-brain barrier disruption for patients with newly diagnosed primary CNS lymphoma. Blood 116(21):2792

    Article  Google Scholar 

  17. Bromberg JEC, Issa S, Bakunina K et al (2019) Rituximab in patients with primary CNS lymphoma (HOVON 105/ALLG NHL 24): a randomised, open-label, phase 3 intergroup study. Lancet Oncol 20(2):216–228

    Article  CAS  Google Scholar 

  18. Rubenstein JL, Fridlyand J, Abrey L et al (2007) Phase I study of intraventricular administration of rituximab in patients with recurrent CNS and intraocular lymphoma. J Clin Oncol 25(11):1350–1356

    Article  CAS  Google Scholar 

  19. Muller C, Murawski N, Wiesen MH et al (2012) The role of sex and weight on rituximab clearance and serum elimination half-life in elderly patients with DLBCL. Blood 119(14):3276–3284

    Article  Google Scholar 

  20. Muldoon LL, Lewin SJ, Dosa E et al (2011) Imaging and therapy with rituximab anti-CD20 immunotherapy in an animal model of central nervous system lymphoma. Clin Cancer Res 17(8):2207–2215

    Article  CAS  Google Scholar 

  21. Ambady P, Fu R, Netto JP et al (2017) Patterns of relapse in primary central nervous system lymphoma: inferences regarding the role of the neuro-vascular unit and monoclonal antibodies in treating occult CNS disease. Fluids Barriers CNS 14(1):16

    Article  Google Scholar 

  22. Jahnke K, Hummel M, Korfel A et al (2006) Detection of subclinical systemic disease in primary CNS lymphoma by polymerase chain reaction of the rearranged immunoglobulin heavy-chain genes. J Clin Oncol 24(29):4754–4757

    Article  CAS  Google Scholar 

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Acknowledgements

This work was supported in part by National Institute of Health Grants CA137488, NS044687, a Veterans Administration Merit Review Grant and the Walter S. and Lucienne Driskill Foundation, all to EAN.

Funding

The authors have no relevant financial disclosures.

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Authors and Affiliations

  1. Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA

    Prakash Ambady, Laszlo Szidonya, Nancy D. Doolittle & Edward A. Neuwelt

  2. School of Public Health, Department of Clinical Epidemiology and Medical Informatics, Oregon Health & Science University, Portland, OR, USA

    Rongwei Fu

  3. Burkhardt Brain Tumor Center, Cleveland Clinic, Cleveland, OH, USA

    David M. Peereboom

  4. Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA

    Edward A. Neuwelt

  5. Portland Veterans Affairs Medical Center, Portland, OR, USA

    Edward A. Neuwelt

Authors
  1. Prakash Ambady
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  2. Rongwei Fu
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  3. Laszlo Szidonya
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  4. David M. Peereboom
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  5. Nancy D. Doolittle
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  6. Edward A. Neuwelt
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Correspondence to Edward A. Neuwelt.

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Ambady, P., Fu, R., Szidonya, L. et al. Impact of maintenance rituximab on duration of response in primary central nervous system lymphoma. J Neurooncol 147, 171–176 (2020). https://doi.org/10.1007/s11060-020-03411-0

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  • DOI: https://doi.org/10.1007/s11060-020-03411-0

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