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Response to Glucocorticoids Predicts Survival with Primary CNS Lymphoma

Response to Glucocorticoids Predicts Survival with Primary CNS Lymphoma

Patients with primary central nervous system (CNS) lymphoma who respond to initial treatment with glucocorticoids appear to have substantially better survival than patients who do not respond. These results were published in the journal Cancer.

Lymphoma is a form of cancer that arises from cells of the lymph system. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes, and circulating immune cells. The main cells in the lymph system are lymphocytes, which exist in two forms: B-cells and T-cells.

Primary CNS lymphoma develops in lymph tissue in the brain, the covering of the brain (meninges), the spinal cord, or the eyes. Most primary CNS lymphomas are B-cell non-Hodgkin’s lymphomas that start in the brain.

Though primary CNS lymphoma rarely spreads outside the central nervous system, it tends to be an aggressive cancer. Treatment often involves chemotherapy and/or radiation therapy. Surgery generally is not an option. Treatment with glucocorticoids (a type of steroid hormone) often produces a transient response. Glucocorticoids may be given prior to definitive treatment with chemotherapy or radiation therapy.

To assess whether survival varies by initial response to glucocorticoids, researchers evaluated primary CNS lymphoma patients identified from the Johns Hopkins Cancer Registry. The study was restricted to patients who were diagnosed between 1980 and 2001, were HIV-negative, and had complete medical record information. A total of 57 patients were identified.

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A clinical response to glucocorticoid treatment was defined as relief of symptoms such as headache. A radiologic response was defined as a reduction in tumor size as identified by computed tomography (CT) or magnetic resonance imaging (MRI).

  • Median survival among all patients was just under 12 months.
  • 48 patients (84%) had a clinical response to glucocorticoid treatment. Median survival was 18 months in patients who had a clinical response to glucocorticoid treatment and 5.5 months in patients who did not have a clinical response to glucocorticoid treatment.
  • Of the 27 patients with CT or MRI results, 16 (59%) had a radiologic response to glucocorticoid treatment. Median survival in patients with a radiologic response was 117 months. Median survival in patients without a radiologic response was 5.5 months.
  • The difference in survival between responders and nonresponders persisted even after accounting for age and treatment.

The researchers conclude that initial response to treatment with glucocorticoids may provide important information about the prognosis of patients with primary CNS lymphoma.

Reference: Mathew BS, Carson KA, Grossman SA. Initial Response to Glucocorticoids: A Potentially Important Prognostic Factor in Patients with Primary CNS Lymphoma. Cancer. 2006;106:383-7.

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