High-Dose Chemotherapy with Autologous Stem Cell Transplantation in Primary Central Nervous System Lymphoma: Data From the Japan Society for Hematopoietic Cell Transplantation Registry |
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| Institution: | 1. Department of Hematology, Kawasaki Medical School, Kurashiki, Japan;2. Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Nagaizumi-cho, Japan;3. Department of Hematology, National Cancer Center Hospital, Tokyo, Japan;4. Medical Oncology Service, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland;5. Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan;6. Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan;7. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan;8. Department of Hematology, Aomori Prefectural Central Hospital, Aomori, Japan;9. Third department of Internal Medicine, Yamagata University School of Medicine, Yamagata, Japan;10. Department of Hematology, Tenri Hospital, Tenri, Japan;11. Department of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan;12. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan;13. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan;14. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan;15. Department of Oncology/Hematology, Shimane University Hospital, Izumo, Japan |
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| Abstract: | High-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) has been shown to improve the prognosis of patients with central nervous system (CNS) lymphoma. We queried the Japan Society for Hematopoietic Cell Transplantation Registry for 2006 to 2015 to analyze the outcomes of 102 patients with primary CNS lymphoma (PCNSL) who underwent first HDT/ASCT. The median patient age was 54 years (range, 20 to 74 years), and 65 patients were treated in an upfront setting. With a median duration of follow-up of 44 months, the 5-year overall survival (OS) and progession-free survival (PFS) were 54.9% and 38.4%, respectively. There were no significant differences in OS and PFS between upfront and salvage HDT/ASCT. Because thiotepa, a key agent in HDT/ASCT for PCNSL, has been unavailable since 2011 in Japan, the HDT regimens used were not uniform. Thiotepa-containing HDT was received by 16 out of 32 patients before 2010, but by only 2 of 70 patients after 2011. Thiotepa-containing HDT was associated with better PFS (P = .019), lower relapse (P = .042), and a trend toward a survival benefit. In multivariate analysis, noncomplete remission at HDT/ASCT was an independent predictor for OS (hazard ratio HR], 2.40; 95% confidence interval CI], 1.25 to 4.58; P = .008) and thiotepa-containing HDT remained significant for PFS (HR, .42; 95% CI, .19 to .95; P = .038). These results confirm the activity of thiotepa-containing regimens. |
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