Journal Article Epublish
PubMed: 42824035 DOI: 10.3389/fonc.2026.1905984
Cumulative pre-chemoimmunotherapy dexamethasone dose is associated with adverse outcomes in primary central nervous system lymphoma.
Front Oncol 16:1905984
Authors: Artem Rafaelian, Sae-Yeon Won, Gleb Dashevskii, Felix M Gerach, Laurèl Rauschenbach, Tatiana Chacón-Quesada, Silvia Hernández Durán, Paulina Guenzerodt, Peter Baumgarten, Dorothee Mielke, Veit Rohde, Ulrich Sure, Henry Schroeder, Claudia Maletzki, Ulrich Langenkamp, Sebastian Böttcher, Christian Junghanss, Bastian von Tresckow, Thomas M Freiman, Florian Gessler, Daniel Dubinski
Affiliations
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany.
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany.
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
- Center for Translational Neuroscience and Behavioral Science, University of Duisburg-Essen, Essen, Germany.
- DKFZ Division of Translational Neurooncology at the West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, A Partnership between DKFZ and University Hospital Essen, University Duisburg-Essen, Essen, Germany.
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany.
- Department of Internal Medicine - Clinic and Polyclinic for Hematology, Hemostaseology, Oncology, Stem Cell Therapy and Palliative Medicine, Rostock University Medical Center, Rostock, Germany.
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center and German Cancer Consortium (DKTK partner site Essen), University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Abstract
INTRODUCTION
Dexamethasone is administered postoperatively and concomitantly with induction regimens and consolidation therapy in patients with primary central nervous system lymphoma (PCNSL). This study aimed to evaluate the impact of cumulative dexamethasone administration prior to systemic chemoimmunotherapy on overall survival (OS) and progression-free survival (PFS) in patients with PCNSL.
METHODS
We conducted a multicenter retrospective study of 105 patients with newly diagnosed, histologically confirmed PCNSL who underwent chemoimmunotherapy between 2014 and 2024. Patients were dichotomized according to cumulative dexamethasone exposure prior to chemoimmunotherapy using an exploratory threshold of 154 mg determined by the maximally selected log-rank statistic.
RESULTS
High cumulative dexamethasone exposure group (HDE, >154 mg) was associated with significantly worse OS (p <.001) and PFS (p <.001) compared with the low cumulative dexamethasone exposure group. In univariate analysis, HDE was significantly associated with poor outcome and increased mortality (p = .0001), whereas other clinical variables such as Karnofsky Performance Status (p = .800), ASA score (p = .052), and tumor volume (p = .778) did not show significant associations. In multivariate Cox regression, cumulative dexamethasone exposure remained independently associated with poorer survival (p = .002), while autologous stem cell transplantation was associated with improved survival (p = .002).
CONCLUSION
HDE prior to chemoimmunotherapy was independently associated with worse survival outcomes in patients with PCNSL. A cumulative dexamethasone dose of 154 mg was identified as an exploratory threshold associated with survival differences and requires prospective validation before clinical implementation.
MeSH
Microscopy, Electron, Scanning Transmission, Dexamethasone, Lymphoma, Central Nervous System, Therapeutics, Nervous System