{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:51:34Z","timestamp":1781632294202,"version":"3.54.5"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurooncol"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal non-Hodgkin lymphoma that predominantly affects elderly individuals. High-dose methotrexate (HD-MTX)-based chemotherapy remains the mainstay of PCNSL treatment, but the optimal combination regimen for elderly patients remains undefined. Nimustine (ACNU), a nitrosourea with excellent blood\u2013brain barrier penetration, has not been evaluated in combination with HD-MTX. We investigated the efficacy and safety of HD-MTX combined with ACNU in elderly PCNSL patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed the cases of 17 untreated PCNSL patients (median age, 71 years) who received the MPA regimen consisting of HD-MTX, procarbazine, and ACNU as induction therapy. None underwent consolidation with whole-brain radiation therapy or high-dose chemotherapy with autologous stem cell transplantation. Clinical characteristics, survival outcomes, and treatment-related adverse events were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall response rate was 100%, with complete response in 65% of the patients. The 2- and 5-year progression-free survival (PFS) rates were 67.6% and 60.1%; the 5-year overall survival rate was 73.3%. Rituximab use was significantly associated with improved PFS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03); cumulative HD-MTX dose and number of ACNU cycles were not. Hematologic toxicities (neutropenia or thrombocytopenia) occurred in 59% of the patients, and hepatic toxicities in 53%. One patient died of sepsis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The MPA regimen yielded high response rates and durable disease control with acceptable toxicity in elderly PCNSL patients without consolidation. Rituximab use correlated with improved PFS. These findings support MPA,\n                      <jats:italic>particularly with rituximab<\/jats:italic>\n                      , as a promising frontline option for consolidation-ineligible patients and warrant prospective validation.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-026-05435-4","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T13:58:19Z","timestamp":1768917499000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Induction chemotherapy with methotrexate, nimustine, and procarbazine for primary CNS lymphoma in the elderly: a retrospective evaluation of safety and efficacy"],"prefix":"10.1007","volume":"176","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1027-1552","authenticated-orcid":false,"given":"Yoshihiro","family":"Umezawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3142-8806","authenticated-orcid":false,"given":"Masahide","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2716-3377","authenticated-orcid":false,"given":"Keisuke","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9206-3137","authenticated-orcid":false,"given":"Kota","family":"Yoshifuji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2627-1055","authenticated-orcid":false,"given":"Hiroki","family":"Akiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6374-3138","authenticated-orcid":false,"given":"Ayako","family":"Nogami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1766-3842","authenticated-orcid":false,"given":"Toshikage","family":"Nagao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8176-4760","authenticated-orcid":false,"given":"Takehiko","family":"Mori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"5435_CR1","doi-asserted-by":"publisher","first-page":"iii1","DOI":"10.1093\/neuonc\/noae047","volume":"26","author":"M Price","year":"2024","unstructured":"Price M, Neff C, Nagarajan N et al (2024) CBTRUS statistical report: American brain tumor association & NCI neuro-oncology branch adolescent and young adult primary brain and other central nervous system tumors diagnosed in the united States in 2016\u20132020. 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M2000-2157).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The requirement for patients\u2019 informed consent was waived based on the study\u2019s retrospective design and the use of anonymized patient data.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All of the manuscript\u2019s authors have reviewed and approved the manuscript for publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Y. Umezawa has received honoraria from Chugai Pharmaceutical and Daiichi Sankyo Co. M. Yamamoto has received honoraria from Chugai Pharmaceutical and Kyowa Kirin. K. Tanaka has received honoraria from Chugai Pharmaceutical. K. Yoshifuji has received honoraria from Chugai Pharmaceutical. A. Nogami has received honoraria from Chugai Pharmaceutical. T. Mori has received honoraria from Pfizer, Chugai Pharmaceutical, Daiichi Sankyo Co. and Kyowa Kirin. The remaining authors have no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"173"}}