Treatment patterns and disease course of previously untreated Primary Central Nervous System Lymphoma: Feasibility of MTX‐based regimens in clinical routine
Background Primary central nervous system lymphoma (PCNSL) is a rare type of aggressive lymphoma of the central nervous system. Treatment strategies improved significantly over the past decades differ regionally but mainly consist of rituximab and high‐dosed methotrexate (MTX)‐based therapies. Metho...
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| Veröffentlicht in: | European journal of haematology 2021-08, Vol.107 (2), p.202-210 |
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| creator | Sieg, Noëlle Naendrup, Jan‐Hendrik Gödel, Philipp Balke‐Want, Hyatt Simon, Florian Deckert, Martina Gillessen, Sarah Kreissl, Stefanie Bröckelmann, Paul J. Borchmann, Peter Tresckow, Bastian Heger, Jan‐Michel |
| description | Background
Primary central nervous system lymphoma (PCNSL) is a rare type of aggressive lymphoma of the central nervous system. Treatment strategies improved significantly over the past decades differ regionally but mainly consist of rituximab and high‐dosed methotrexate (MTX)‐based therapies.
Methods
We assessed clinical outcomes of 100 patients with newly diagnosed PCNSL between 2010‐2020 at the University Hospital of Cologne, Germany.
Results
Patients were 23‐88 years of age and either treated with MTX‐based regimens (PRIMAIN, MARTA, MATRix), individual regimens, or best supportive care, respectively. Overall response rates were generally high (66,7‐83,8%), but different organ toxicities required dose adjustments in most groups. Two‐year overall survival rates were 57,9% (PRIMAIN), 63,6% (MARTA), 65,4% (MATRix), and 37,5% (Other), respectively. Out of 9 patients suffering from relapse >12 months from primary diagnosis, 7 patients (77,8%) received methotrexate‐based salvage therapy with 2‐year overall survival of 4/6 patients (66,7%).
Conclusion
Although a relevant proportion of patients are not eligible for clinical trials due to age, performance status, or comorbidities, these results prove feasibility of different MTX‐based treatment strategies in clinical routine. Even elderly patients displayed surprisingly favorable outcomes. However, with compromising organ toxicities, reduction of intensity should be part of strategies in future clinical trials. |
| doi_str_mv | 10.1111/ejh.13639 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2524358332</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2524358332</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3889-48ce19219211dee6ab54ff47753407372ca18398308a2edef0f603284c06b8443</originalsourceid><addsrcrecordid>eNp1kc9u1DAQhy0EotvCgRdAlrjAIe04dhKbG1q1FLT8kVgkbpHjTKhXiZPaSVFufQSeoA_XJ6mXtByQsCzN5fPnmfkR8oLBMYvnBHcXx4znXD0iK5YDJJCDekxWoCBNhBDsgByGsAOAVLHiKTngXOWQ8WxFbrYe9dihG-mgxxG9C1S7mtY2oA5ITT_5WPqGDh6vbD-FdqaTG_evsKZfve20n-k6Crxu6Wf0V5Gh3-YwYkc3czdc9J1-S8-izVa2teO8l33a_ri9_l3FH2rq8aeNDQRqHTWtddZEke-n0Tp8Rp40ug34_L4eke9np9v1ebL58v7D-t0mMVxKlQhpkKl0f1mNmOsqE00jiiLjAgpepEYzyZXkIHWKNTbQ5MBTKQzklRSCH5HXi3fw_eWEYSw7Gwy2rXYY5ynTLBU8k5ynEX31D7qLO3Kxu0gJqQAkzyL1ZqGM70Pw2JTDsqqSQbkPrYyhlX9Ci-zLe-NUdVj_JR9SisDJAvyyLc7_N5WnH88X5R0Lg6NR</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2548900835</pqid></control><display><type>article</type><title>Treatment patterns and disease course of previously untreated Primary Central Nervous System Lymphoma: Feasibility of MTX‐based regimens in clinical routine</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Sieg, Noëlle ; Naendrup, Jan‐Hendrik ; Gödel, Philipp ; Balke‐Want, Hyatt ; Simon, Florian ; Deckert, Martina ; Gillessen, Sarah ; Kreissl, Stefanie ; Bröckelmann, Paul J. ; Borchmann, Peter ; Tresckow, Bastian ; Heger, Jan‐Michel</creator><creatorcontrib>Sieg, Noëlle ; Naendrup, Jan‐Hendrik ; Gödel, Philipp ; Balke‐Want, Hyatt ; Simon, Florian ; Deckert, Martina ; Gillessen, Sarah ; Kreissl, Stefanie ; Bröckelmann, Paul J. ; Borchmann, Peter ; Tresckow, Bastian ; Heger, Jan‐Michel</creatorcontrib><description>Background
Primary central nervous system lymphoma (PCNSL) is a rare type of aggressive lymphoma of the central nervous system. Treatment strategies improved significantly over the past decades differ regionally but mainly consist of rituximab and high‐dosed methotrexate (MTX)‐based therapies.
Methods
We assessed clinical outcomes of 100 patients with newly diagnosed PCNSL between 2010‐2020 at the University Hospital of Cologne, Germany.
Results
Patients were 23‐88 years of age and either treated with MTX‐based regimens (PRIMAIN, MARTA, MATRix), individual regimens, or best supportive care, respectively. Overall response rates were generally high (66,7‐83,8%), but different organ toxicities required dose adjustments in most groups. Two‐year overall survival rates were 57,9% (PRIMAIN), 63,6% (MARTA), 65,4% (MATRix), and 37,5% (Other), respectively. Out of 9 patients suffering from relapse >12 months from primary diagnosis, 7 patients (77,8%) received methotrexate‐based salvage therapy with 2‐year overall survival of 4/6 patients (66,7%).
Conclusion
Although a relevant proportion of patients are not eligible for clinical trials due to age, performance status, or comorbidities, these results prove feasibility of different MTX‐based treatment strategies in clinical routine. Even elderly patients displayed surprisingly favorable outcomes. However, with compromising organ toxicities, reduction of intensity should be part of strategies in future clinical trials.</description><identifier>ISSN: 0902-4441</identifier><identifier>EISSN: 1600-0609</identifier><identifier>DOI: 10.1111/ejh.13639</identifier><identifier>PMID: 33960535</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols - adverse effects ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; ASCT ; B‐NHL ; Central nervous system ; Central Nervous System Neoplasms - diagnosis ; Central Nervous System Neoplasms - drug therapy ; Central Nervous System Neoplasms - mortality ; Clinical trials ; Combined Modality Therapy ; Female ; Germany ; Humans ; IELSG ; Lymphoma ; Lymphoma - diagnosis ; Lymphoma - drug therapy ; Lymphoma - mortality ; Male ; MARTA ; MATRix ; Methotrexate ; Methotrexate - administration & dosage ; Middle Aged ; Nervous system ; Patients ; PCNSL ; Practice Patterns, Physicians ; PRIMAIN ; Prognosis ; Recurrence ; Retreatment ; Rituximab ; Survival ; Survival Analysis ; Treatment Outcome ; Young Adult</subject><ispartof>European journal of haematology, 2021-08, Vol.107 (2), p.202-210</ispartof><rights>2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><rights>2021. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3889-48ce19219211dee6ab54ff47753407372ca18398308a2edef0f603284c06b8443</citedby><cites>FETCH-LOGICAL-c3889-48ce19219211dee6ab54ff47753407372ca18398308a2edef0f603284c06b8443</cites><orcidid>0000-0001-9463-8504</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fejh.13639$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fejh.13639$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33960535$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sieg, Noëlle</creatorcontrib><creatorcontrib>Naendrup, Jan‐Hendrik</creatorcontrib><creatorcontrib>Gödel, Philipp</creatorcontrib><creatorcontrib>Balke‐Want, Hyatt</creatorcontrib><creatorcontrib>Simon, Florian</creatorcontrib><creatorcontrib>Deckert, Martina</creatorcontrib><creatorcontrib>Gillessen, Sarah</creatorcontrib><creatorcontrib>Kreissl, Stefanie</creatorcontrib><creatorcontrib>Bröckelmann, Paul J.</creatorcontrib><creatorcontrib>Borchmann, Peter</creatorcontrib><creatorcontrib>Tresckow, Bastian</creatorcontrib><creatorcontrib>Heger, Jan‐Michel</creatorcontrib><title>Treatment patterns and disease course of previously untreated Primary Central Nervous System Lymphoma: Feasibility of MTX‐based regimens in clinical routine</title><title>European journal of haematology</title><addtitle>Eur J Haematol</addtitle><description>Background
Primary central nervous system lymphoma (PCNSL) is a rare type of aggressive lymphoma of the central nervous system. Treatment strategies improved significantly over the past decades differ regionally but mainly consist of rituximab and high‐dosed methotrexate (MTX)‐based therapies.
Methods
We assessed clinical outcomes of 100 patients with newly diagnosed PCNSL between 2010‐2020 at the University Hospital of Cologne, Germany.
Results
Patients were 23‐88 years of age and either treated with MTX‐based regimens (PRIMAIN, MARTA, MATRix), individual regimens, or best supportive care, respectively. Overall response rates were generally high (66,7‐83,8%), but different organ toxicities required dose adjustments in most groups. Two‐year overall survival rates were 57,9% (PRIMAIN), 63,6% (MARTA), 65,4% (MATRix), and 37,5% (Other), respectively. Out of 9 patients suffering from relapse >12 months from primary diagnosis, 7 patients (77,8%) received methotrexate‐based salvage therapy with 2‐year overall survival of 4/6 patients (66,7%).
Conclusion
Although a relevant proportion of patients are not eligible for clinical trials due to age, performance status, or comorbidities, these results prove feasibility of different MTX‐based treatment strategies in clinical routine. Even elderly patients displayed surprisingly favorable outcomes. However, with compromising organ toxicities, reduction of intensity should be part of strategies in future clinical trials.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Combined Chemotherapy Protocols - adverse effects</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>ASCT</subject><subject>B‐NHL</subject><subject>Central nervous system</subject><subject>Central Nervous System Neoplasms - diagnosis</subject><subject>Central Nervous System Neoplasms - drug therapy</subject><subject>Central Nervous System Neoplasms - mortality</subject><subject>Clinical trials</subject><subject>Combined Modality Therapy</subject><subject>Female</subject><subject>Germany</subject><subject>Humans</subject><subject>IELSG</subject><subject>Lymphoma</subject><subject>Lymphoma - diagnosis</subject><subject>Lymphoma - drug therapy</subject><subject>Lymphoma - mortality</subject><subject>Male</subject><subject>MARTA</subject><subject>MATRix</subject><subject>Methotrexate</subject><subject>Methotrexate - administration & dosage</subject><subject>Middle Aged</subject><subject>Nervous system</subject><subject>Patients</subject><subject>PCNSL</subject><subject>Practice Patterns, Physicians</subject><subject>PRIMAIN</subject><subject>Prognosis</subject><subject>Recurrence</subject><subject>Retreatment</subject><subject>Rituximab</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0902-4441</issn><issn>1600-0609</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kc9u1DAQhy0EotvCgRdAlrjAIe04dhKbG1q1FLT8kVgkbpHjTKhXiZPaSVFufQSeoA_XJ6mXtByQsCzN5fPnmfkR8oLBMYvnBHcXx4znXD0iK5YDJJCDekxWoCBNhBDsgByGsAOAVLHiKTngXOWQ8WxFbrYe9dihG-mgxxG9C1S7mtY2oA5ITT_5WPqGDh6vbD-FdqaTG_evsKZfve20n-k6Crxu6Wf0V5Gh3-YwYkc3czdc9J1-S8-izVa2teO8l33a_ri9_l3FH2rq8aeNDQRqHTWtddZEke-n0Tp8Rp40ug34_L4eke9np9v1ebL58v7D-t0mMVxKlQhpkKl0f1mNmOsqE00jiiLjAgpepEYzyZXkIHWKNTbQ5MBTKQzklRSCH5HXi3fw_eWEYSw7Gwy2rXYY5ynTLBU8k5ynEX31D7qLO3Kxu0gJqQAkzyL1ZqGM70Pw2JTDsqqSQbkPrYyhlX9Ci-zLe-NUdVj_JR9SisDJAvyyLc7_N5WnH88X5R0Lg6NR</recordid><startdate>202108</startdate><enddate>202108</enddate><creator>Sieg, Noëlle</creator><creator>Naendrup, Jan‐Hendrik</creator><creator>Gödel, Philipp</creator><creator>Balke‐Want, Hyatt</creator><creator>Simon, Florian</creator><creator>Deckert, Martina</creator><creator>Gillessen, Sarah</creator><creator>Kreissl, Stefanie</creator><creator>Bröckelmann, Paul J.</creator><creator>Borchmann, Peter</creator><creator>Tresckow, Bastian</creator><creator>Heger, Jan‐Michel</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QG</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9463-8504</orcidid></search><sort><creationdate>202108</creationdate><title>Treatment patterns and disease course of previously untreated Primary Central Nervous System Lymphoma: Feasibility of MTX‐based regimens in clinical routine</title><author>Sieg, Noëlle ; Naendrup, Jan‐Hendrik ; Gödel, Philipp ; Balke‐Want, Hyatt ; Simon, Florian ; Deckert, Martina ; Gillessen, Sarah ; Kreissl, Stefanie ; Bröckelmann, Paul J. ; Borchmann, Peter ; Tresckow, Bastian ; Heger, Jan‐Michel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3889-48ce19219211dee6ab54ff47753407372ca18398308a2edef0f603284c06b8443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Combined Chemotherapy Protocols - adverse effects</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>ASCT</topic><topic>B‐NHL</topic><topic>Central nervous system</topic><topic>Central Nervous System Neoplasms - diagnosis</topic><topic>Central Nervous System Neoplasms - drug therapy</topic><topic>Central Nervous System Neoplasms - mortality</topic><topic>Clinical trials</topic><topic>Combined Modality Therapy</topic><topic>Female</topic><topic>Germany</topic><topic>Humans</topic><topic>IELSG</topic><topic>Lymphoma</topic><topic>Lymphoma - diagnosis</topic><topic>Lymphoma - drug therapy</topic><topic>Lymphoma - mortality</topic><topic>Male</topic><topic>MARTA</topic><topic>MATRix</topic><topic>Methotrexate</topic><topic>Methotrexate - administration & dosage</topic><topic>Middle Aged</topic><topic>Nervous system</topic><topic>Patients</topic><topic>PCNSL</topic><topic>Practice Patterns, Physicians</topic><topic>PRIMAIN</topic><topic>Prognosis</topic><topic>Recurrence</topic><topic>Retreatment</topic><topic>Rituximab</topic><topic>Survival</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sieg, Noëlle</creatorcontrib><creatorcontrib>Naendrup, Jan‐Hendrik</creatorcontrib><creatorcontrib>Gödel, Philipp</creatorcontrib><creatorcontrib>Balke‐Want, Hyatt</creatorcontrib><creatorcontrib>Simon, Florian</creatorcontrib><creatorcontrib>Deckert, Martina</creatorcontrib><creatorcontrib>Gillessen, Sarah</creatorcontrib><creatorcontrib>Kreissl, Stefanie</creatorcontrib><creatorcontrib>Bröckelmann, Paul J.</creatorcontrib><creatorcontrib>Borchmann, Peter</creatorcontrib><creatorcontrib>Tresckow, Bastian</creatorcontrib><creatorcontrib>Heger, Jan‐Michel</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Animal Behavior Abstracts</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of haematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sieg, Noëlle</au><au>Naendrup, Jan‐Hendrik</au><au>Gödel, Philipp</au><au>Balke‐Want, Hyatt</au><au>Simon, Florian</au><au>Deckert, Martina</au><au>Gillessen, Sarah</au><au>Kreissl, Stefanie</au><au>Bröckelmann, Paul J.</au><au>Borchmann, Peter</au><au>Tresckow, Bastian</au><au>Heger, Jan‐Michel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment patterns and disease course of previously untreated Primary Central Nervous System Lymphoma: Feasibility of MTX‐based regimens in clinical routine</atitle><jtitle>European journal of haematology</jtitle><addtitle>Eur J Haematol</addtitle><date>2021-08</date><risdate>2021</risdate><volume>107</volume><issue>2</issue><spage>202</spage><epage>210</epage><pages>202-210</pages><issn>0902-4441</issn><eissn>1600-0609</eissn><abstract>Background
Primary central nervous system lymphoma (PCNSL) is a rare type of aggressive lymphoma of the central nervous system. Treatment strategies improved significantly over the past decades differ regionally but mainly consist of rituximab and high‐dosed methotrexate (MTX)‐based therapies.
Methods
We assessed clinical outcomes of 100 patients with newly diagnosed PCNSL between 2010‐2020 at the University Hospital of Cologne, Germany.
Results
Patients were 23‐88 years of age and either treated with MTX‐based regimens (PRIMAIN, MARTA, MATRix), individual regimens, or best supportive care, respectively. Overall response rates were generally high (66,7‐83,8%), but different organ toxicities required dose adjustments in most groups. Two‐year overall survival rates were 57,9% (PRIMAIN), 63,6% (MARTA), 65,4% (MATRix), and 37,5% (Other), respectively. Out of 9 patients suffering from relapse >12 months from primary diagnosis, 7 patients (77,8%) received methotrexate‐based salvage therapy with 2‐year overall survival of 4/6 patients (66,7%).
Conclusion
Although a relevant proportion of patients are not eligible for clinical trials due to age, performance status, or comorbidities, these results prove feasibility of different MTX‐based treatment strategies in clinical routine. Even elderly patients displayed surprisingly favorable outcomes. However, with compromising organ toxicities, reduction of intensity should be part of strategies in future clinical trials.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33960535</pmid><doi>10.1111/ejh.13639</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-9463-8504</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Antineoplastic Combined Chemotherapy Protocols - adverse effects Antineoplastic Combined Chemotherapy Protocols - therapeutic use ASCT B‐NHL Central nervous system Central Nervous System Neoplasms - diagnosis Central Nervous System Neoplasms - drug therapy Central Nervous System Neoplasms - mortality Clinical trials Combined Modality Therapy Female Germany Humans IELSG Lymphoma Lymphoma - diagnosis Lymphoma - drug therapy Lymphoma - mortality Male MARTA MATRix Methotrexate Methotrexate - administration & dosage Middle Aged Nervous system Patients PCNSL Practice Patterns, Physicians PRIMAIN Prognosis Recurrence Retreatment Rituximab Survival Survival Analysis Treatment Outcome Young Adult |
| title | Treatment patterns and disease course of previously untreated Primary Central Nervous System Lymphoma: Feasibility of MTX‐based regimens in clinical routine |
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