Intensive chemotherapy followed by autologous stem cell transplantation in primary central nervous system lymphomas (PCNSLs). Therapeutic outcomes in real life-experience of the French Network.

Abstract

We analysed the therapeutic outcomes of all consecutive patients with primary central nervous system lymphoma (PCNSL) registered in the prospective French database for PCNSL and treated with intensive chemotherapy (IC) followed by autologous stem cell transplantation (IC-ASCT) between 2011 and November 2019 (271 patients recruited, 266 analysed). In addition, treatment-related complications of thiotepa-based IC-ASCT were analysed from the source files of 85 patients from 3 centers. Patients had received IC-ASCT either in first-line treatment (n = 147) or at relapse (n = 119). The median age at IC-ASCT was 57 years (range: 22-74). IC consisted of thiotepa-BCNU (n = 64), thiotepa-busulfan (n = 24), BCNU-etoposide-cytarabine-melphalan (BEAM, n = 36) and thiotepa-busulfan-cyclophosphamide (n = 142). In multivariate analysis, BEAM and ASCT beyond the first relapse were adverse prognostic factors for relapse risk. The risk of treatment-related mortality was higher for ASCT performed beyond the first relapse and seemed higher for thiotepa-busulfan-cyclophosphamide. Thiotepa-BCNU tends to result in a higher relapse rate than thiotepa-busulfan-cyclophosphamide and thiotepa-busulfan. This study confirms the role of IC-ASCT in first-line treatment and at first-relapse PCNSL (5-year overall survival rates of 80 and 50%, respectively). The benefit/risk ratio of thiotepa-busulfan/thiotepa-busulfan-cyclophosphamide-ASCT could be improved by considering ASCT earlier in the course of the disease and dose adjustment of the IC.

• Authors: Laurence Schenone, Caroline Houillier, Marie Laure Tanguy, Sylvain Choquet, Kossi Agbetiafa, Hervé Ghesquières, Gandhi Damaj, Anna Schmitt, Krimo Bouabdallah, Guido Ahle, Remy Gressin, Jérôme Cornillon, Roch Houot, Jean-Pierre Marolleau, Luc-Matthieu Fornecker, Olivier Chinot, Frédéric Peyrade, Reda Bouabdallah, Cécile Moluçon-Chabrot, Emmanuel Gyan, Adrien Chauchet, Olivier Casasnovas, Lucie Oberic, Vincent Delwail, Julie Abraham, Virginie Roland, Agathe Waultier-Rascalou, Lise Willems, Franck Morschhauser, Michel Fabbro, Renata Ursu, Catherine Thieblemont, Fabrice Jardin, Adrian Tempescul, Denis Malaise, Valérie Touitou, Lucia Nichelli, Magali Le Garff-Tavernier, Aurélie Plessier, Philippe Bourget, Caroline Bonmati, Sophie Wantz-Mézières, Quentin Giordan, Véronique Dorvaux, Cyril Charron, Waliyde Jabeur, Khê Hoang-Xuan, Luc Taillandier, Carole Soussain, French network for oculocerebral lymphoma (LOC network)
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 57 Issue 6 Pg. 966-974 (06 2022) ISSN: 1476-5365 [Electronic] England
• PMID: 35422077 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Nature Limited.

Chemical References

• Etoposide
• Cyclophosphamide
• Thiotepa
• Busulfan
• Carmustine

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Busulfan
• Carmustine (therapeutic use)
• Central Nervous System (pathology)
• Central Nervous System Neoplasms (drug therapy, pathology)
• Cyclophosphamide (therapeutic use)
• Etoposide
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Lymphoma (drug therapy)
• Neoplasm Recurrence, Local (drug therapy)
• Prospective Studies
• Thiotepa
• Transplantation, Autologous
• Treatment Outcome