Onkológia 1/2024

Primary lymphomas of the central nervous system – results of treatment in Slovak centres

Purpose: PCNSLs account for approximately 4-6% of all extranodal lymphomas. This aggressive form of non-Hodgkin›s lymphoma (NHL), arises in the brain, spinal cord, eye or leptomeninges without signs of systemic involvement. It is manifested by a wide range of neurological symptoms, which reflects its multifocal nature. The backbone of systemic therapy is high-dose methotrexate, which is mostly used in combination with other chemotherapy drugs. According to ESMO recommendations, the use of the MATRIX protocol is currently standard in Europe in this indication, namely for patients who are able to undergo consolidation with high-dose chemotherapy and autologous peripheral stem cell transplantation (ASCT). Patients and methods: In our work, we retrospectively evaluated the data of 29 patients who were treated at the National Cancer Institute in Bratislava (NOU BA), at the Hematology Department of the FNsP F.D. Roosevelt in Banská Bystrica, at the Department of Hematology and Transfusiology of the University Hospital in Martin and at the Department of Hematology and Oncohematology of the UNLP in Košice from year 2018 to 2023. Our retrospective analysis includes the initial characteristics of the patients, details of the administered treatment, evaluation of the treatment response, treatment toxicity and comparison of treatment results in the use of the MATRIX protocol versus other protocols. Results: There were 17 patients treated according to the MATRIX protocol, 12 patients were treated according to the De Angelis protocol and the CHOD/BVAM protocol. The median age of MATRIX treated patients was lower (47 years) compared to the group treated with other treatment protocols (61.5 years). Patients treated according to the MATRIX protocol had better baseline ECOG performance rate. Mortality during therapy with the MATRIX protocol was at the level of 24%, mortality during therapy with the De Angelis protocol and CHOD/BVAM was at the level of 42%. Thiotepa was administered in induction treatment to only 58% of patients, which was caused by the unavailability of this drug in a certain period of time. We confirmed the impact of ASCT consolidation by deepening treatment responses in accordance with IELSG43. As of 12/2023, 52% of patients treated by MATRIX protocol and 33% of patients treated by De Angelis protocol and CHOD/BVAM were in complete remission. Conclusion: In the sample of patients treated according to the MATRIX protocol in Slovak centers, we observed comparable but lower levels of complete remissions than in the IELSG32. The lower number of patients and the imbalance of the initial characteristics of the patients in the MATRIX group and in the group treated by the De Angelis protocol and CHOD/BVAM in terms of different ECOG and patient age make it impossible to accurately compare the efficacy of these protocols. Our analysis of patients with PCNSL also supports the ESMO recommendations, according to which we consider the MATRIX protocol to be the current standard of therapy for patients suitable for this treatment in Slovak oncohematological centers.

Keywords: lymphoma, CNS involvement, MATRIX, methotrexate, primary CNS lymphoma