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Cyclophosphamide, doxorubicin, vincristine, and prednisone for primary central nervous system lymphoma

Short-duration response and multifocal intracerebral recurrence preceding radiotherapy

Divisions of Neurology (Drs. Lachance, Brown, and Schold) and Hematology-Oncology (Dr. Gockerman), Department of Medicine; the Department of Radiation Oncology (Drs. Brizel and Halperin); the Division of Neuropathology (Dr. Burger), Department of Pathology: and the Division of Neuroradiology (Dr. Boyko), Department of Radiology, Duke University Medical Center, Durham, NC.

The activity of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in the treatment of primary central nervous system lymphoma (PCNSL) prior to radiotherapy was studied in six patients. Primary lesions were reduced by 80% or more on contrast-enhancing cross-sectional area in four patients and to a lesser extent in two others after two cycles of chemotherapy. The primary lesion sites demonstrated no contrast enhancement in the three patients who completed four cycles of therapy. However, concurrent with response at the primary disease sites, multiple lesions occurred at distant, noncontiguous CNS parenchymal sites in five patients after two to four cycles of chemotherapy. Median survival was 8.5 months for the six enrolled patients and 16.5 months for the four patients completing craniospinal radiotherapy. PCNSL is highly responsive to standard systemic non-Hodgkin's lymphoma chemotherapy regimens, but the pattern and rapidity of relapse suggest mechanisms of failure including inherent or rapidly evolving antineoplastic drug resistance and perhaps limited drug delivery to occult sites of disease in the brain.

Address correspondence and reprint requests to Dr. S.C. Schold, Jr., Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9036.

Drs. Lachance and Boyko were supported in part by a training grant from NINDS (T32-07304).

Received May 10, 1993. Accepted in final form February 14, 1994.

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