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The C5R protocol: a regimen of high-dose chemotherapy and radiotherapy in
primary cerebral non-Hodgkin's lymphoma of patients with no known cause of
immunosuppression [see comments]
JY Blay, D Bouhour, C Carrie, E Bouffet, M Brunat-Mentigny, T Philip and P Biron
Department of Medicine, Centre Leon Berard, Lyon, France.
In most reported series, less than 20% of patients with primary cerebral
non-Hodgkin's lymphoma (PCL) and no known cause of immunodepression are
alive and disease-free 5 years after the initial diagnosis. Whether
chemotherapy improves the outcome of these patients remains unclear. We
report a pilot study of a protocol (C5R) with 5 courses of chemotherapy
followed by cranial radiotherapy in 25 adult patients with PCL and no known
cause of immunodepression. The median age was 51 years (range, 16 to 70
years) and the median performance status was 2 (range, 1 to 4) in this
series. Fourteen patients (56%) achieved a complete response and 4 (16%)
achieved a partial response 1 month after the completion of the treatment.
Four patients died in the first month of treatment because of progression
(n = 1) or toxicity (n = 3). In 3 patients, the treatment could not be
performed because of patient refusal (n = 1) or severe infections (n = 2).
Myelosuppression was the most frequent side effect; febrile neutropenia
occurred in 96%, 89%, 69%, and 74% of the patients after the second, third,
fourth, and fifth courses of chemotherapy, respectively. Grade 4
thrombocytopenia occurred in 20% of the patients. With a median follow-up
of 24 months, the projected survival of the group at 2 and 5 years is 70%
and 56%, respectively. The 4 early deaths occurred in the subgroup of 6
patients greater than 60 years of age with an international prognostic
index (IPI) greater than 3. In the 19 remaining patients (76% of this
series) less than 61 years of age or with an IPI less than 4, the projected
overall survival at 2 and 5 years is 88% and 70%, respectively. The C5R
protocol is a highly efficient regimen in nonimmunosuppressed patients with
PCL less than 61 years of age or with an IPI less than 4.
Volume 86,
Issue 8,
pp. 2922-2929,
10/15/1995
Copyright © 1995 by The American Society of Hematology
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