Consolidative Autologous Stem Cell Transplantation Versus Whole Brain Radiation in PCNSL; a Nationwide Analysis |
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| Institution: | 1. Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh PA;2. Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore MD;3. Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh PA;1. Department of Medical Oncology;2. Adult Hematolymphoid Unit;3. Department of Pathology;4. Department of Radiation Oncology;5. Department of Nuclear medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, India;6. Homi Bhabha National Institute, Mumbai, India;1. Yale University School of Medicine, New Haven CT, USA;2. University of Miami School of Medicine, Miami, Florida, USA;3. Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA;4. Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA;5. Department of Hematopathology, Yale University School ofMedicine, New Haven, CT, USA;1. Department of Internal Medicine, Cleveland Clinic Main Campus, Cleveland, OH;2. Sarah Cannon – Nashville TN;1. Department of Applied Pharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan;2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;3. Real World Data Enabling Platform, Roche Products Ltd, Welwyn Garden City, UK;4. Department of Basic Pharmaceutical Sciences, Isra University, Amman, Jordan;5. Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan;6. Faculty of Medicine, Umm Alqura University, Saudi Arabia;7. The Adelaide Medical School, University of Adelaide, Adelaide, Australia;1. Leukemia/BMT Program of BC, BC Cancer, Vancouver, BC, Canada;2. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada;3. Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada;4. Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada;5. Division of Infectious Diseases, Department of Medicine, University of Alberta, AB, Edmonton, Canada;6. Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;7. Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute; Morsani College of Medicine, University of South Florida, Tampa, FL, USA |
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| Abstract: | BackgroundThe best consolidation strategy after induction chemotherapy in Primary CNS Lymphoma (PCNSL) remains controversial. Our objective is to estimate the overall survival (OS) for autologous stem cell transplantation (ASCT) versus whole brain radiation (WBRT) in the consolidation setting. We also sought to evaluate the factors affecting treatment selectionMethodsWe identified 1620 patients with PCNSL who received chemotherapy followed by either ASCT or WBRT between 2004 and 2015 from the National Cancer Database. A propensity score weighting methodology was used to compare survival outcomes. Factors affecting treatment selection were investigated using a logistic regression model. Annual percentage change (APC) was calculated to assess the trend of ASCT use.ResultsOnly 12.2% of patients received ASCT, and this proportion rose steadily between 2004 and 2015, with APC of +23%. Treatment selection was affected by age, type of area, distance from the treating facility, and level of education. With a median follow-up of 68.4 months, adjusted-median OS was 91.4 months and not reached for WBRT and ASCT groups, respectively (P < .001). 5-year OS was 74.4% in the ASCT group versus 58.7% in the WBRT group (HR 0.40, 95% CI 0.27-0.60, P -value < .01).ConclusionSocioeconomic factors affect the selection of consolidative treatment in patients with PCNSL which can alter outcomes. Frequency of consolidative ASCT is increasing for patients with PCNSL. This is the first and largest cohort study, to our knowledge, to show an OS advantage in favor of ASCT. This OS benefit needs to be confirmed in a randomized controlled fashion. |
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