Oops, you're using an old version of your browser so some of the features on this page may not be displaying properly.

MINIMAL Requirements: Google Chrome 24+Mozilla Firefox 20+Internet Explorer 11Opera 15–18Apple Safari 7SeaMonkey 2.15-2.23

Poster display session

5108 - Safety and Tolerability of Chemotherapy (CT) Containing High Doses of Methotrexate (HD-MTX) and Cytarabine (Ara-C) in Patients with Primary Central Nervous System Lymphoma (PCNSL) and Hepatitis B Virus (HBV) Infection

Date

09 Sep 2017

Session

Poster display session

Topics

Lymphomas

Presenters

Teresa Calimeri

Citation

Annals of Oncology (2017) 28 (suppl_5): v355-v371. 10.1093/annonc/mdx373

Authors

T. Calimeri1, P. Lopedote1, M. Repetto1, A. Vignati1, M. Sassone1, C. Cecchetti1, S. Perrone1, M. Foppoli1, G. Ciboddo1, S. Girlanda1, J. Peccatori2, A. Chiara3, M. Memoli4, A. Ferreri1

Author affiliations

  • 1 Unit Of Lymphoid Malignancies, Department Of Oncohematology, IRCCS San Raffaele, 20132 - Milan/IT
  • 2 Hematology Unit Dept. Of Onco-hematological Medicine, IRCCS San Raffaele, 20132 - Milan/IT
  • 3 Radiotherapy Uradiotherapy Unit, Department Of Oncohematology, IRCCS San Raffaele, 20132 - Milan/IT
  • 4 Immunopathology And Advanced Medical Care, IRCCS San Raffaele, 20132 - Milan/IT
More

Resources

Abstract 5108

Background

HBV reactivation is a serious complication of some anticancer therapies. Preliminary studies suggested high rates of HBV reactivation, with fatal outcome, in pts with PCNSL treated with standard HD-MTX-based CT. Risk of HBV reactivation is further increased by the use of Rituximab (Rtx), which significantly improves efficacy of CT in PCNSL. Hence, HBV-positive pts are usually excluded from prospective trials, with a negative effect on accrual, and are treated with less intensive therapies, resulting in lower cure rates. Herein, we report the incidence of HBV infection and reactivation in a mono-institutional series of PCNSLs treated with modern strategies.

Methods

HIV-negative pts with newly diagnosed PCNSL treated with CT containing HD-MTX and Ara-C ± rituximab at our Institution, from 2010 to 2016, were analyzed to establish incidence of HBV infection, hepatotoxicity and treatment-related viral reactivation.

Results

48 pts (median age 58, range 29–76) were considered. Eight (17%) pts had “resolved” HBV infection (negative HBsAg but positive anti-surface [anti-HBs] or anti-core [anti-HBc] Antibodies), one (2%) pt had active infection. HBV prophylaxis with lamivudine was indicated in 3/8 pts with resolved HBV. The pt with active infection was treated with entecavir. Induction comprised HD-MTX plus Ara-C in 2 pts, HD-MTX, Ara-C and Rtx in 2, and HD-MTX, Ara-C, thiotepa and Rtx in 5 (MATRix). Transient grade 1-2 elevation of hepatic enzymes (AST, ALT, GGT) was observed in all pts; grade 3-4 was recorded in 17/39 (44%) HBV-negative pts and in 5/9 (56%) HBV-positive pts (Fisher exact; p = 0.71). Eight out of 9 HBV-positive pts received the 4 planned CT courses without dose reductions due to hepatotoxicity; six pts achieved a CR and received consolidation (WBRT 2, ASCT 3, lenalidomide maintenance 1). At a median follow-up of 27 months for the whole series (12-88), no pt experienced HBV reactivation during first-line treatment, 5 pts remain relapse-free.

Conclusions

This study suggests that MTX-Ara-C-based therapy, MATRix regimen, in particular, can be safely used in PCNSL pts with HBV infection, without impaired life expectancy.

Clinical trial identification

None

Legal entity responsible for the study

IRCCS San Raffaele

Funding

None

Disclosure

All authors have declared no conflicts of interest.

This site uses cookies. Some of these cookies are essential, while others help us improve your experience by providing insights into how the site is being used.

For more detailed information on the cookies we use, please check our Privacy Policy.

Customise settings
  • Necessary cookies enable core functionality. The website cannot function properly without these cookies, and you can only disable them by changing your browser preferences.