Autologous Stem Cell Transplantation in Central Nervous System Lymphoma: A Multicenter Retrospective Series and a Review of the Literature |
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| Institution: | 1. Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL;2. Program for Comparative Effectiveness Research, University of South Florida College of Medicine, Tampa, FL;3. Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL;1. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY;2. Myeloproliferative Disorders Clinical Research Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY;1. Division of Hematology & HCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia;2. King Abdullah International Medical Research Center;3. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia;4. Department of Medical Imaging, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia;1. Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, OH;2. Bristol-Myers Squibb, Princeton, NJ;3. Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL;1. Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA;2. Department of Medicine, Washington University School of Medicine, St. Louis, MO;1. University of Michigan Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI;2. Department of Biostatistics, University of Michigan, Ann Arbor, MI;3. Division of Hematology, Stanford University, Stanford, CA;4. Department of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, AZ;5. University of Texas Health San Antonio Cancer Center, San Antonio, TX |
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| Abstract: | BackgroundCentral 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 MethodsWe 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.ResultsThe 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.ConclusionIn 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. |
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| Keywords: | Non-relapse mortality Overall survival Primary central nervous system lymphoma Relapse/progression Secondary central nervous system lymphoma |
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