Presenting Author: Dr. Ranjit Kumar Sahoo
Key Words: Primary Central Nervous System Lymphoma, PCNSL, Retrospective, India
Conflict of Interest/Funding: None
Context: Inspite of numerous advances in the field of PCNSL, there are significant barriers with respect to managing this rare and aggressive brain neoplasm. There is no population based data for PCNSL in India and in such scenario a large hospital-based data may put some light.
Setting: All India Institute of Medical Sciences (AIIMS) is a tertiary care center in the Northern part of India.
Objective: To analyze outcome of patients diagnosed with PCNSL.
Design: This is a retrospective study spanning over 17 years from 2001-2017. The median duration of follow-up is 34 months.
Results: Out of 99 patients, only one patient was found positive for HIV-serology. The median age was 50 years (13-70 years) with a male: female ratio of 1.91. The median duration of symptoms before diagnosis was 3.5 months (0.5-48 months); which was commonly motor abnormality (60.6%). In 81.8% of patients, there were multiple intracranial lesions predominantly in the supratentorial location. Performance status of 3 or more was seen in 58.5%. The most common histology was DLBCL (97.7%). Approximately 30% of patients were not eligible for treatment because of the poor general condition. Surgical resection was performed in 45% (n=40) due to suspicion of glioma or other brain tumor (n=36). Most patients (n=73) were treated with MVP+R without any pharmacokinetic monitoring of MTX with acceptable toxicity (HDMTX-related mortality of 3.9%). The median EFS and OS were 20.4 months and 31.7 months respectively. Addition of rituximab to MVP (n=27) resulted in higher ORR (88.9% vs. 73.9%, p=0.12), CR (81.5% vs. 56.5%, p=0.03), 2-year EFS (57.3% vs. 40.4%, p=0.02) and 2-year OS (61.6% vs. 53.4%, p=0.056) as compared to MVP alone.
Conclusion: This is the largest study of PCNSL from India representative of the experiences across all parts of the country. Patients were younger, immunocompetent and presented with a high-burden disease at baseline (multiple lesions, poor PS) with ~22% patients being unsuitable for any curative treatment. The outcome of patients who could be treated appears comparable to the west with addition of rituximab showing a benefit. The toxicity of HDMTX without pharmacokinetic monitoring was acceptable.

35 / Primary Central Nervous System Lymphoma in India: A 17-year Experience from AIIMS.