EVALUATING TREATMENT TIMELINES AND SURVIVAL OUTCOMES FOR PRIMARY CNS LYMPHOMA: A CROSS-SECTIONAL EVALUATION

Abstract

Objectives: This study assesses clinical outcomes for primary central nervous system lymphoma (PCNSL) patients, particularly focusing on the timelines from diagnosis to hospital arrival, treatment initiation, and overall survival. It examines the impact of these timelines on patient outcomes and evaluates the effectiveness of a treatment regimen that includes high-dose methotrexate, cytarabine, and rituximab on survival rates in first line. Material and methods: Conducted as a cross-sectional study in the hematology ward of Hospital Geral de Fortaleza, this research evaluates patients diagnosed with PCNSL. Clinical parameters such as age, time to chemotherapy initiation, and time to death are collected. Data are summarized using medians and interquartile ranges (IQR). Group comparisons are facilitated using non-parametric tests, specifically the Mann-Whitney U-test, with p-values < 0.05 considered statistically significant. Overall survival (OS) is assessed using the Kaplan-Meier method, maintaining a 95% confidence interval. Results: Median patient age is 45.5 years (IQR: 39.8 to 52.0), and the median time from diagnosis to hospital arrival is -7.00 days (IQR: -19.0 to 17.0), suggesting some patients were referred before formal diagnosis. The median time from diagnosis to treatment initiation is 36 days (IQR: 31.0 to 55.0). The median survival time post-diagnosis is 7.07 months (IQR: 3.22 to 18.6), with the primary treatment regimen consisting of high-dose methotrexate, cytarabine, and rituximab. The 2-year OS is 25%, with 66.7% of patients dying within one year of diagnosis. Discussion: The variability in the timelines from diagnosis to hospital arrival and treatment initiation among PCNSL patients highlights a critical need for more efficient care processes. The early referral of some patients indicates an urgent referral protocol for highly suspected cases, yet the substantial range in treatment initiation times could impact patient outcomes significantly. The aggressive nature of the disease is underscored by a median survival time of 7.07 months, with a significant percentage of patients dying within the first year post-diagnosis, suggesting potential inadequacies in the treatment protocol. Conclusion: The findings suggest an urgent need for more streamlined diagnostic and treatment protocols to improve the efficacy of lymphoma care. The significant mortality rate within a year of diagnosis and the low overall survival rate necessitate a re-evaluation of the standard treatment regimen to better meet patient needs. This study advocates for further research to optimize treatment timelines and regimen efficacy to enhance patient prognosis and combat the severity of lymphoma more effectively.