The Real-World status and risk factors for a poor prognosis in elderly patients with primary central nervous system malignant lymphomas: a multicenter retrospective cohort study of the Tohoku Brain Tumor Study Group 

Abstract Introduction The number of elderly patients with primary central nervous system malignant lymphoma(EL-PCNSL) has been increasing. However, due to their poor pre-treatment Karnofsky Performance Status(KPS) and many comorbidities, it is possible that sufficient treatment has not been performed. We therefore conducted a retrospective cohort study to evaluate risk factors associated with a poor prognosis of the Real-World status of EL-PCNSL in the Tohoku Brain Tumor Study Group. Methods Patients aged ≥ 71 years with PCNSL were enrolled from 8 centers. Univariate analysis was performed by the log-rank test. A Cox proportional hazards model was used for multivariate analysis. Results Three of total 142 cases received best supportive care(BSC) from the beginning. Treatment was given to 30 cases without a pathological diagnosis, 3 cases with a cerebrospinal fluid diagnosis, and 100 cases with CD20-positive DLBCL diagnosis. Total 133 cases(median age 76 years) were included. The median pre-treatment KPS was 50%. There were 117(88.0%) patients with 213 pre-treatment comorbidities(1.8 comorbidities per patient). PFS and OS were 16 months and 24 months, respectively. Risk factors associated with poor prognosis on Cox proportional hazards model were pre-treatment cardiovascular disease and central nervous system disease comorbidities, post-treatment pneumonia and other infections, and the absence of radiation or chemotherapy. Conclusions EL-PCNSL was actively treated and BSC was only a few. Pre-treatment comorbidities and post-treatment complications would influence the prognosis. Radiation and chemotherapy were found to be effective, but no conclusions could be drawn regarding the content of chemotherapy and whether additional radiation therapy should be used.