© 1999 by Society
© 1999 by the Society forNeuro-Oncology
The consequences of treatment and disease in patients with primary CNSnon-Hodgkin's lymphoma: Cognitive function and performance status
Coordinated by the North Central Cancer Treatment Group, Rochester,MN 55905
2 Address correspondence and reprint requests to B.P. O'Neill, M.D., Departmentof Neurology, Mayo Clinic and Foundation, 200 SW First St., Rochester, MN55905.
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Abstract |
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Per protocol, patients with primary CNS non-Hodgkin's lymphoma in anintergroup phase II trial conducted by the North Central Cancer TreatmentGroup and the Eastern Cooperative Oncology Group had their cognitive functionsmeasured using the Folstein and Folstein Mini-Mental Status Examination (MMSE)and their physical functions measured using the Eastern Cooperative OncologyGroup Performance Score (PS) at study entry, at each treatment evaluation, andat quarterly intervals thereafter until disease progression or death. Of the53 eligible participants who began therapy, 46 (87%) had baseline MMSE scoresrecorded, 36 (68%) had at least one follow-up MMSE, and 32 (60%) had both,while 52 (98%) had baseline PS, 49 (92%) had at least one follow-up PS, and 48(91%) had both. Patterns of MMSE and PS values over time were studied in eachindividual, in the group as a whole, in the 20 patients who completed thestudy regimen, in the 23 who survived more than a year, and in patients whowere classified as nonprogressors at each key evaluation. For each patient,all recorded values were plotted versus time, with dates of diseaseprogression and death included, to look for signs of decline in cognitive orphysical function preceding adverse events. Long-term declines in scores ofboth cognitive and physical function were observed in many treated patientswith primary CNS non-Hodgkin's lymphoma. Nearly all patients who were alivemore than 52 weeks after study entry had a demonstrable decline in cognitiveand physical functionality. Such declines may occur before disease progressionis documented; they may also occur in some patients who have long-termfollow-up without evidence of disease progression. Declining MMSE and PS was apoor predictor of disease progression. There was no association of PS andtoxicity. The data from this study demonstrated the considerable difficultieswe encountered conducting an ancillary study such as this within a multicenterclinical trial. Firstly, the test instruments written into the protocol wereunable to tell if the declines seen were due to disease, treatment,co-morbidity, or other factors. Secondly, the missing data createddifficulties in interpreting outcome.
Received October 9, 1998; Accepted March 29, 1999
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