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Annals of Oncology Advance Access originally published online on April 7, 2006
Annals of Oncology 2006 17(7):1141-1145; doi:10.1093/annonc/mdl070
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© 2006 European Society for Medical Oncology

Prospective trial on topotecan salvage therapy in primary CNS lymphoma

L. Fischer1,*, E. Thiel1, H.-A. Klasen2, J. Birkmann3, K. Jahnke1, P. Martus4 and A. Korfel1

1 Department of Haematology, Oncology and Transfusion Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin; 2 Department of Radiotherapy and Oncology, Pius-Hospital, Oldenburg; 3 Department of Hematology and Oncology, Klinikum Nord; Nürnberg; 4 Institute for Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany

* Correspondence to: Dr L. Fischer, Department of Hematology, Oncology and Transfusion Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. Tel: +49-30-8445-2337; Fax: +49-30-8445-4468; E-mail: lars.fischer{at}charite.de

Background: Standard salvage therapy has not been established for recurrent primary central nervous system lymphoma (PCNSL). We report the final results of a prospective study on topotecan chemotherapy in relapsed or refractory PCNSL.

Patients and methods: The study included 27 patients with a median age of 51 years and an ECOG performance status of 2. Fourteen patients were refractory to the last therapy, and 13 relapsed after a median period of 6.0 months. Pretreatment with up to four regimens included chemotherapy in 26 patients and whole brain irradiation in 14. A 30-min daily topotecan infusion of 1.5 mg/m2 for 5 days was repeated every 3 weeks.

Results: The response rate was 33% with five complete (CR) and four partial remissions (PR). The median follow-up was 37.7 months. All complete responders had sustained remissions lasting for 9 to 28 months. The median event-free survival (EFS) was 2.0 months (9.1 months in responders), the overall survival (OAS) was 8.4 months. CTC grade 3–4 leukopenia occurred in 26% and thrombocytopenia in 11% of the patients. Eight of 12 patients alive without cerebral lymphoma ≥ six months after topotecan exhibited deficits attributable to late neurotoxicity.

Conclusion: Topotecan as monotherapy is active in relapsed and refractory PCNSL with tolerable toxicity.

Key words: PCNSL, salvage therapy, topotecan


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