Effectiveness and safety of thiotepa as conditioning treatment prior to stem cell transplant in patients with central nervous system lymphoma.

Abstract

BACKGROUND:

Thiothepa is a cytostatic agent used in managing solid malignancies, and also as conditioning treatment before hematopoietic stem cell transplantation [HSCT]. This systematic review summarizes evidence on its effectiveness and safety, in patients with central nervous system [CNS] lymphoma.

METHODS:

We searched 3 databases for clinical studies. When feasible, we performed meta-analyses.

RESULTS:

We identified 13 eligible studies, none of which with a priori controls. So data synthesis focused on the 226 patients who received thiotepa. Based on pooled estimates, 75.9% of thiotepa-treated patients achieved a complete remission (95% confidence interval [CI] = 67.5-82.8), and 61.7% had a progression-free survival for up to 125 months post-treatment (95% CI = 49.4-72.7). However, 25.5% relapsed, 24.6% experienced infection, and 13.2% experienced neurotoxicity.

DISCUSSION:

Thiotepa-based conditioning followed by HSCT may be effective in most CNS lymphoma patients, with a manageable toxicity profile. But adequately powered randomized trials are needed to better evaluate and isolate the effects of thiotepa.

• Authors: Madzouka B Kokolo, Dean Fergusson, Joseph O'Neill, Jason Tay, Alan T Tinmouth, Douglas Stewart, Chris Bredeson
• Journal: Leukemia & lymphoma (Leuk Lymphoma) Vol. 55 Issue 12 Pg. 2712-20 (Dec 2014) ISSN: 1029-2403 [Electronic] United States
• PMID: 24491026 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Myeloablative Agonists
• Thiotepa

Topics

• Central Nervous System Neoplasms (complications, pathology, therapy)
• Hematopoietic Stem Cell Mobilization (methods)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Lymphoma (complications, pathology, therapy)
• Myeloablative Agonists (administration & dosage, adverse effects, therapeutic use)
• Neoplasm Recurrence, Local
• Publication Bias
• Thiotepa (administration & dosage, adverse effects, therapeutic use)
• Transplantation Conditioning
• Treatment Outcome