Successful change of treatment strategy in elderly patients with primary central nervous system lymphoma by de-escalating induction and introducing temozolomide maintenance : results from a phase II study by The Nordic Lymphoma Group

The Nordic Lymphoma Group has conducted a phase ll trial in newly diagnosed primary central nervous system lymphoma patients applying an age-adjusted multi-agent immunochemotherapy regimen, which in elderly patients included temozolomide maintenance treatment. Patients aged 18-75 years were eligible. Thirty-nine patients aged 18-65 years and 27 patients aged 66-75 years were enrolled. The median age of the two age groups was 55 and 70 years, respectively. The overall response rate was 73.8% for the entire cohort: 69.9% in the younger and 80.8% in the elderly subgroup. With a median follow up of 22 months, the 2-year overall survival probability was 60.7% in patients aged 65 years or under and 55.6% in patients aged over 65 years (P=0.40). The estimated progression-free survival at two years was 33.1% (95% CI: 19.1%-47.9%) in patients aged under 65 years and 44.4% (95% CI: 25.6%-61.8%) in the elderly subgroup (P=0.74). Median duration of response was ten months in the younger subgroup, and not reached in the elderly patient subgroup (P=0.33). Four patients aged 64-75 years (6%) died from treatment-related complications. Survival in the two age groups was similar despite a de-escalation of induction treatment in patients aged over 65 years. Duration of response in elderly patients receiving maintenance temozolomide was longer than in the younger age subgroup. While toxicity during induction is still of concern, especially in the elderly patients, we conclude from these data that de-escalation of induction therapy in elderly primary central nervous system lymphoma patients followed by maintenance treatment seems to be a promising treatment strategy.Peer reviewe

Healed or non-healed? Computed tomography (CT) visualisation of morphology of bite trace ichnotaxa on a dinosaur bone

Bite traces on fossilised bones can provide important information on predator-prey relations and interactions in ancient environments. In 2009, two new ichnotaxa, Linichnus serratus and Knethichnus parallelum, were introduced to develop the application of bite traces as an ichnological tool. Ichnotaxa defined by theropod bite traces can provide useful information for understanding feeding behaviour. However, objective interpretation of possible bite traces can be difficult using traditional visual inspection. In this study, the bite traces on a fossilised dinosaur bone were comprehensively examined by correlating traditional naked-eye in spection with computed tomography (CT) imaging, used to visualise the internal morphology of the bite traces and in particular, to clarify the appearance of one possibly healed bite trace. A forensic pathologist visually examined the bone with the aid of stereomicroscopy and a radiologist analysed the CT scans. Sixteen different scanner settings were used to optimise the CT parameters and avoid signal at tenuation, in the form of hypointense artefacts in the central trabeculated part of the bone fragment. The use of CT scanning provided information on internal morphology from the vicinity of the bite trace, including hyperdense zones, not identified using visual inspection alone. By applying the extended CT scale, the dense and radiopaque cortical bone layer could be clearly identified and applied as a pathomorphological marker to correctly distinguish non-healed from healed wounds. In conclusion, the authors demonstrate that external visual examination of trace fossils by ichnologists in combination with interior examination using CT imaging can be applied to characterise ichnotaxa defined by bite traces and potentially provide clues on ancient feeding behaviour