Prognostic Scoring System for Primary CNS Lymphomas: The International Extranodal Lymphoma Study Group Experience

To identify survival predictors and to design a prognostic score useful for distinguishing risk groups in immunocompetent patients with primary CNS lymphomas (PCNSL). The prognostic role of patient-, lymphoma-, and treatment-related variables was analyzed in a multicenter series of 378 PCNSL patient...

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Published in:	Journal of clinical oncology Vol. 21; no. 2; pp. 266 - 272
Main Authors:	FERRERI, Andrés J. M, BLAY, Jean-Yves, DEVIZZI, Liliana, BERGER, Francoise, PONZONI, Maurilio, BORISCH, Betting, TINGUELY, Marianne, CERATI, Michele, MILANI, Mario, ORVIETO, Enrico, SANCHEZ, Juvenal, CHEVREAU, Christine, RENI, Michele, DELL'ORO, Stefania, ZUCCA, Emanuele, CAVALLI, Franco, PASINI, Felice, SPINA, Michele, AMBROSETTI, Achille, CALDERONI, Antonello, ROSSI, Andrea, VAVASSORI, Vittorio, CONCONI, Annarita
Format:	Journal Article
Language:	English
Published:	Baltimore, MD American Society of Clinical Oncology 15-01-2003 Lippincott Williams & Wilkins
Subjects:	Adolescent Adult Age Distribution Aged Aged, 80 and over Antineoplastic Combined Chemotherapy Protocols Biological and medical sciences Central Nervous System Neoplasms - diagnosis Central Nervous System Neoplasms - drug therapy Central Nervous System Neoplasms - mortality Cerebrospinal Fluid - metabolism Female Hematologic and hematopoietic diseases Humans L-Lactate Dehydrogenase - metabolism Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Lymphoma - diagnosis Lymphoma - drug therapy Lymphoma - mortality Male Medical sciences Middle Aged Neoplasm Staging Prognosis Remission Induction Risk Factors Surveys and Questionnaires Survival Rate Treatment Outcome Performance evaluation Human Intracranial Nervous system diseases Prognosis Enzyme Evaluation scale Central nervous system Malignant hemopathy Tumorous infiltration Cerebrospinal fluid Non Hodgkin lymphoma L-Lactate dehydrogenase Protein Cerebral disorder Extraganglionar Lymphoproliferative syndrome Central nervous system disease Oxidoreductases Age Deep level
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Summary:	To identify survival predictors and to design a prognostic score useful for distinguishing risk groups in immunocompetent patients with primary CNS lymphomas (PCNSL). The prognostic role of patient-, lymphoma-, and treatment-related variables was analyzed in a multicenter series of 378 PCNSL patients treated at 23 cancer centers from five different countries. Age more than 60 years, performance status (PS) more than 1, elevated lactate dehydrogenase (LDH) serum level, high CSF protein concentration, and involvement of deep regions of the brain (periventricular regions, basal ganglia, brainstem, and/or cerebellum) were significantly and independently associated with a worse survival. These five variables were used to design a prognostic score. Each variable was assigned a value of either 0, if favorable, or 1, if unfavorable. The values were then added together to arrive at a final score, which was tested in 105 assessable patients for which complete data of all five variables were available. The 2-year overall survival (OS) +/- SD was 80% +/- 8%, 48% +/- 7%, and 15% +/- 7% (P =.00001) for patients with zero to one, two to three, and four to five unfavorable features, respectively. The prognostic role of this score was confirmed by limiting analysis to assessable patients treated with high-dose methotrexate-based chemotherapy (2-year OS +/- SD: 85% +/- 8%, 57% +/- 8%, and 24% +/- 11%; P =.0004). Age, PS, LDH serum level, CSF protein concentration, and involvement of deep structures of the brain were independent predictors of survival. A prognostic score including these five parameters seems advisable in distinguishing different risk groups in PCNSL patients. The proposed score and its relevance in therapeutic decision deserve to be validated in further studies.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0732-183X 1527-7755
DOI:	10.1200/JCO.2003.09.139