Page 348 - Haematologica Vol. 109 - July 2024

LETTER TO THE EDITOR
Seidel et al.8 reported a Bonn group’s study with a 10-year OS rate of 9% in patients above 60 years of age at diagnosis whereas there were no long-term survivors at 10 years in the other phase II trial MATILDE reported by Ferreri et al.9 Compared to these results, the long-term survival of elderly patients in our trial is significantly higher. With the median OS of 33.3 months among elderly patients in our study, the results remain more favorable also compared to other stud- ies specifically designed for elderly PCNSL patients (with a median OS ranging from 14 to 17.5 months).7,10-12
In summary, the Nordic PCNSL study was finalized as planned 10 years after the end of treatment. Seventeen of 66 patients were alive and in good health based on their PS (ECOG PS of 0-1 in most of the long-term survivors), MMSE, and FIM scores (at or close to the maximum level in almost all long- term survivors). We conclude that, in our study, consolida- tion with maintenance temozolomide has been beneficial regarding survival in vulnerable elderly PCNSL patients. Based on our results, we suggest future clinical trials for elderly PCNSL patients to study novel agents in combination with a HD-MTX-based induction immunochemotherapy regimen without HD-cytarabine, followed by maintenance temo- zolomide consolidation. Additional, preferably randomized, studies, are warranted to clarify whether consolidation with maintenance therapy could be of benefit to sustain remission and improve survival also in younger PCNSL pa- tients, particularly those that are not fit for dose-intensive consolidation therapy. Having the potential for late relaps- es and neurotoxicity in mind, we find that all prospective PCNSL clinical trials should routinely report at least 10-year follow-up results in the future.
Authors
Elisa Jacobsen Pulczynski,1,2 Mikkel Runason Simonsen,3,4 Outi Kuittinen,5,6 Unn-Merete Fagerli,7,8 Martin Erlanson,9 Øystein Fluge,10 Sirpa Leppä,11,12 Bjørn Østenstad,13 Alexander Fosså,13,14 Mikael Eriksson,15,16 Tarec El-Galaly,17 Hanne Kuitunen,18 Karin Papworth,9 Maria Ljungqvist,19,20 Martin B. Pedersen1 and Marjukka Pollari11,21
1Department of Hematology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Hematology, Region Hospital Goedstrup, Herning, Denmark; 3Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; 4Department of Mathematical Sciences, Aalborg University, Aalborg, Denmark; 5Department of Oncology, Kuopio University Hospital Cancer Center, Kuopio, Finland; 6Faculty of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; 7Department of Oncology, St Olav University Hospital, Trondheim, Norway; 8Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; 9Department of Radiation Sciences, Umeå University, Umeå, Sweden; 10Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; 11Research Programs Unit/Applied Tumor
Genomics Research Program, University of Helsinki, Helsinki, Finland; 12Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland; 13Department of Oncology, Oslo University Hospital, Oslo, Norway; 14KG Jebsen Center for B-cell Malignancies, University of Oslo, Oslo, Norway; 15Department of Oncology, Skane University Hospital, Lund, Sweden; 16Medical Oncology, Lund University, Lund, Sweden; 17Department of Hematology, Aalborg University Hospital, Aalborg, Denmark; 18Cancer Center, Oulu University Hospital, Oulu, Finland; 19Department of Clinical Science and Education, Södersjukhuste, Karolinska Insitutet, Stockholm, Sweden; 20Hematology Center, Karolinska University Hospital, Stockholm, Sweden and 21Department of Oncology, Tays Cancer Center, Tampere University Hospital, Tampere, Finland
Correspondence:
M. POLLARI - marjukka.pollari@pirha.fi
https://doi.org/10.3324/haematol.2024.285207
Received: February 1, 2024. Accepted: March 19, 2024. Early view: March 28, 2024.
©2024 Ferrata Storti Foundation Published under a CC BY-NC license
Disclosures
No conflicts of interest to disclose.
Contributions
EJP was the principal investigator (PI) of the study, the national PI in Denmark, responsible for the design of the study, data management, accrual of patients in Denmark, and wrote the manuscript together with MP. MRS performed data analysis. OK was involved in protocol planning, was the national PI in Finland, and responsible for accrual of patients in Finland. UMF was involved in protocol planning, was the national PI in Norway, and responsible for accrual of patients in Norway. ME was involved in protocol planning, was the national PI in Sweden, and responsible for accrual of patients in Sweden. ØF, BØ, and AF recruited and treated patients in Norway. SL recruited and treated patients in Finland. ME recruited and treated patients in Sweden. TEG, HK, KP, ML, and MBP are current members of the Nordic Primary Central Nervous System Lymphoma Group and were involved in writing the manuscript. MP is the chair of the Nordic Primary Central Nervous System Lymphoma Group, the corresponding author of this study, performed data analysis together with MRS, and wrote, revised as well as reformated the manuscript together with EJP.
Funding
This work was funded by grants from Nordic Cancer Union, Norpharma, Roche, Schering-Plough, and Inge og Jørgen Larsens Mindelegat.
Data-sharing statement
No shared data are available.
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