Temozolomide as a Single Agent Maintenance Therapy in Elderly Patients With Primary CNS Lymphoma

Introduction: Optimal management of elderly patients with primary central nervous system lymphoma (PCNSL) after induction therapy is unclear. Whole-brain radiotherapy and autologous stem cell transplantation carry increased toxicity in patients older than 60 years of age, which might outweigh the benefits in this group. Temozolomide (TMZ) has established antineoplastic activity in the central nervous system in other disease states, with a favorable toxicity profile. Patients and Methods: We report efficacy and tolerability in a series of 10 patients treated off-label with TMZ maintenance after completion of R-MPV (rituximab, methotrexate, procarbazine and vincristine) treatment for or primary diagnosed PCNSL. Results: Median progression-free survival (PFS) was 57 months, 2-year PFS was 67%, and 5-year PFS was 33%. Median overall survival (OS) was 63 months, 2-year OS was 88%, and 5-year OS was 57%. TMZ was generally well tolerated, with the most common toxicity of Grade 3 or higher being thrombocytopenia in 3 patients (30%). Conclusion: These outcomes suggest that TMZ might have activity for maintenance in elderly patients with PCNSL, when more aggressive treatments are contraindicated. Optimal management of elderly patients with primary central nervous system lymphoma (PCNSL) after induction therapy is unclear. In our retrospective series of 10 patients treated with temozolomide after induction with R-MPV (rituximab, methotrexate, procarbazine and vincristine) we found a median progression-free survival of 57 months, and a median overall survival of 63 months, with moderate toxicity, which supports the idea that temozolomide might have activity for maintenance in elderly patients with PCNSL.