Systemic chemotherapy alone for patients with non-acquired immunodeficiency syndrome-related central nervous system lymphoma

A pilot study of the BOMES protocol

Authors

  • Ann-Lii Cheng M.D., Ph.D.,

    Corresponding author
    1. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    2. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
    3. Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
    • Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
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  • Kun-Huei Yeh M.D.,

    1. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
    2. Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
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  • Wu-Ching Uen M.D.,

    1. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
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  • Ruey-Long Hung M.D., Ph.D.,

    1. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
    2. Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
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  • Mei-Ying Liu R.N.,

    1. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
    2. Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
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  • Chiu-Hwa Wang M.D.

    1. Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
    2. Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
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  • Presented in part at the Annual Meeting of the American Society of Clinical Oncology, Dallas, Texas, May 16-17, 1994.

Abstract

BACKGROUND

Anecdotal reports have suggested that systemic chemotherapy with agents that better cross the blood-brain barrier may result in long term disease remission in some patients with central nervous system (CNS) lymphoma. This treatment strategy has the advantage of sparing patients the late neurologic complications from brain irradiation.

METHODS

Eligible patients were required to 1) have tissue-proven and measurable non-acquired immunodeficiency syndrome (AIDS)- related primary or metastatic CNS lymphoma; 2) have normal hemogram, renal function, and hepatic function; 3) be age ≤ 75 years; and 4) have provided informed consent. Patients with lymphoblastic lymphoma or patients who previously had been exposed to nitrosoureas, etoposide, or high dose methotrexate were not eligible. The systemic chemotherapy (BOMES regimen) included carmustine, 65 mg/m2/day, intravenously (i.v.) on Days 1-2; vincristine, 2 mg/day, i.v. on Days 1 and 8; methotrexate, 1.5 g/m2, i.v. on day 15 followed by leucovorin rescue; etoposide, 50 mg/m2/day, i.v. on Days 1-5; and methylprednisolone, 200 mg/day, i.v. on Days 1-7; repeated every 4 weeks (BOMES regimen). Four doses of intrathecal methotrexate were given to patients who had involvement in the cerebrospinal fluid.

RESULTS

Between March 1991 and March 1997 a total of 19 patients were enrolled on the study. There were 13 men and 6 women, with a median age of 57 years. Fourteen patients had primary CNS lymphoma and 5 patients had concurrent extra-CNS lymphoma. Nine patients previously had been treated by radiotherapy (four patients), chemotherapy (three patients), or both (two patients). There were 11 complete remissions (CR) (57.9%) and 5 partial remissions (26.3%), with a total remission rate of 84.2%. One patient had had progressive brain lymphoma during systemic chemotherapy with the conventional cyclophosphamide, doxorubicin, vincristine, and prednisolone regimen, but achieved CR soon after the regimen was changed to BOMES. The median time to progression of the responders was 6 months. At last follow-up, 4 patients were alive without lymphoma at 10, 47, 64, and 66 months, respectively. There were two treatment-related deaths due to sepsis. Another two patients died of fulminant hepatitis that most likely was chemotherapy-related reactivation of chronic B viral hepatitis.

CONCLUSIONS

The authors believe systemic chemotherapy alone may result in long term disease remission in some select patients with non-AIDS-related CNS lymphoma. Further investigation for better protocols is mandatory. Cancer 1998;82:1946-51. © 1998 American Cancer Society.

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