Autologous Stem Cell Transplantation in Central Nervous System Lymphoma: A Multicenter Retrospective Series and a Review of the Literature.

Abstract

BACKGROUND:

Central nervous system (CNS) lymphoma is associated with poor outcomes. Autologous stem cell transplantation (ASCT) has been reported to improve outcomes when used as a consolidation strategy in primary CNS lymphoma (PCNSL) and as a salvage strategy in patients with disease relapse limited to the CNS. Herein, we describe our experience of using ASCT in PCNSL and secondary CNS lymphoma (SCNSL).

PATIENTS AND METHODS:

We evaluated clinical outcomes of 18 patients from 2 major academic centers with a median age of 55 (range, 46-72) years. Thirteen patients had PCNSL and 5 patients had SCNSL. Most of the cases were in the first (CR1) or second (CR2) complete remission (CR1 = 7, CR2 = 7) at the time of ASCT. Carmustine with thiotepa (n = 12, 67%) was the most commonly prescribed preparative regimen.

RESULTS:

The median follow-up from ASCT for surviving patients was 12 (range, 0.9-115) months. The 2-year progression-free survival (PFS) and overall survival (OS) were 74% (95% confidence interval [CI], 48%-99%) and 80% (95% CI, 55%-100%), respectively. Two-year non-relapse mortality was 0%. The 2-year cumulative incidence of relapse/progression was 27% (95% CI, 10%-72%). In subgroup analysis of PCNSL patients, 2-year PFS, OS, and relapse were 71% (95% CI, 38%-100%), 71% (95% CI, 38%-100%), and 29% (95% CI, 9%-92%), respectively.

CONCLUSION:

In this retrospective study of patients with CNS lymphoma, consolidation with ASCT after high-dose methotrexate-based chemotherapy is safe and effective in reducing disease relapse.

• Authors: Bhagirathbhai R Dholaria, Ambuj Kumar, Abdel-Ghani Azzuqua, Taiga Nishihori, Mohamed A Kharfan-Dabaja, Han W Tun, Ernesto Ayala
• Journal: Clinical lymphoma, myeloma & leukemia (Clin Lymphoma Myeloma Leuk) Vol. 19 Issue 6 Pg. e273-e280 (06 2019) ISSN: 2152-2669 [Electronic] United States
• PMID: 30914301 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Aged
• Central Nervous System Neoplasms (diagnosis, mortality, therapy)
• Combined Modality Therapy (methods)
• Female
• Hematopoietic Stem Cell Transplantation (adverse effects, methods)
• Humans
• Lymphoma (diagnosis, mortality, therapy)
• Male
• Middle Aged
• Retrospective Studies
• Transplantation, Autologous
• Treatment Outcome