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Annals of Oncology Advance Access published online on April 7, 2006
Annals of Oncology, doi:10.1093/annonc/mdl070
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© 2006 European Society for Medical Oncology
Received December 10, 2005
Revised February 24, 2006
Accepted March 1, 2006

original article

Prospective trial on topotecan salvage therapy in primary CNS lymphoma

L. Fischer 1 *, E. Thiel 1, H.-A. Klasen 2, J. Birkmann 3, K. Jahnke 1, P. Martus 4, and A. Korfel 1

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

* To whom correspondence should be addressed.
L. Fischer, E-mail: lars.fischer{at}charite.de


  Abstract

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.

Keywords: PCNSL; salvage therapy; topotecan.
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