A search of the literature did not find strong evidence to support the use of MBVP in the treatment of PCNSL. The expert reference panel supported publication of the protocol on the basis of the information summarised below. The committee was most strongly influenced by the phase II study by Poortmans et al.r
Up to the early 1990s whole-brain radiation therapy (WBRT) was the standard treatment for patients with primary central nervous system lymphoma (PCNSL). However, since then many studies have been published on the efficacy of high dose Methotrexate (HD-MTX)-based chemotherapy. Despite the absence of phase III data, sufficient phase II data have been accumulated to allow consensus on the improved efficacy of sequential chemo- and radiation therapy over radiation therapy alone.rrrr
The evidence supporting this protocol is provided by a prospective phase II trial of the European Organization for Research and Treatment of Cancer (EORTC) involving 52 patients. The purpose of the trial was to confirm the feasibility and estimate the efficacy of methotrexate (MTX), teniposide, carmustine and methylprednisolone (MBVP) chemotherapy combined with radiation therapy (RT) for patients with non-AIDS-related primary CNS lymphoma (PCNSL) treated in a multicentre setting.r
Between October 1997 and February 2002, 52 patients were registered to receive two cycles of methotrexate (MTX), teniposide, carmustine and methylprednisolone (MBVP) every 28 days followed by consolidating RT.r
The primary end point was response rate and safety of this chemotherapy regimen. Secondary end points were duration of response, progression-free survival, overall survival, improvement of cognitive functions, and quality of life.r
The MBVP regimen followed by RT has a high response rate and an acceptable toxicity.r
Source |
Study & Year Published |
Supports Use |
Is the dose and regimen consistent with the protocol? |
Comments |
Phase II trials |
Poortmans et al 2003r |
Yes |
Yes |
|
N/A |
N/A |
N/A |
|
Case series |
N/A |
N/A |
N/A |
|
Observational studies |
N/A |
N/A |
N/A |
|
Guidelines |
Date published/revised |
Supports Use |
Is the dose and regimen consistent with the protocol? |
Comments |
NCCN |
N/A |
N/A |
N/A |
|
BCCA |
N/A |
N/A |
N/A |
|
CCO |
N/A |
N/A |
N/A |
|
Efficacy
After a median follow up of 27 months, the overall response rate was 81%.r


© Journal of Clinical Oncology
Toxicity
Grade 3 and 4 haematologic toxicity was observed in 78% of patients for WBC count only, 24% of patients for platelets and in 14% of patients for anaemia. Grade 3 and 4 non-haematologic toxicity was limited and included a grade 4 infection in two patients and a grade 3 infection in six patients, neurologic toxicity in six patients, a possible treatment-induced depression in one patient, stomatitis in four patients (one grade 4), genitourinary toxicity in three patients (one grade 4), thromboembolic complications in four patients (one grade 4), liver toxicity in two patients (one grade 4), allergic reactions (including hypotension) in two patients, and skin toxicity in one patient. The acute chemotherapy-induced toxicity was mainly leukocytopenia which caused death in 5 patients despite hospitalization.r