High-dose chemotherapy and autologous stem cell transplantation for primary central nervous system lymphoma: a multi-centre retrospective analysis from the United Kingdom

The prognosis of patients with primary central nervous system lymphoma (PCNSL) has improved in recent years. This has partly been achieved by remission induction protocols incorporating high-dose methotrexate (HD-MTX) and rituximab. Given the high rates of relapse, consolidation therapy is usually c...

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Bibliographic Details
Published in:	Bone marrow transplantation (Basingstoke) Vol. 52; no. 9; pp. 1268 - 1272
Main Authors:	Kassam, S, Chernucha, E, O’Neill, A, Hemmaway, C, Cummins, T, Montoto, S, Lennard, A, Adams, G, Linton, K, McKay, P, Davies, D, Rowntree, C, Easdale, S, Eyre, T A, Marcus, R, Cwynarski, K, Fox, C P
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 01-09-2017 Nature Publishing Group
Subjects:	692/699/1541/1990/291/1621/1915 692/700/565/2319 Adult Aged Antineoplastic Combined Chemotherapy Protocols - therapeutic use Autografts Bone marrow Brain Care and treatment Cell Biology Central nervous system Central Nervous System Neoplasms - drug therapy Central Nervous System Neoplasms - pathology Central Nervous System Neoplasms - therapy Chemotherapy Cognition Consolidation Drug Therapy - methods Feasibility studies Female Hematology Hematopoietic Stem Cell Transplantation - methods Humans Internal Medicine Lymphoma Lymphoma - drug therapy Lymphoma - pathology Lymphoma - therapy Lymphomas Male Medical prognosis Medicine Medicine & Public Health Methotrexate Middle Aged Monoclonal antibodies Nervous system Neurotoxicity original-article Patients Public Health Radiation dosage Radiation therapy Radiotherapy Remission Retrospective Studies Rituximab Stem cell transplantation Stem Cells Survival Targeted cancer therapy Transplantation Transplantation, Autologous - methods Transplants & implants United Kingdom United Kingdom United Kingdom > UK
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Summary:	The prognosis of patients with primary central nervous system lymphoma (PCNSL) has improved in recent years. This has partly been achieved by remission induction protocols incorporating high-dose methotrexate (HD-MTX) and rituximab. Given the high rates of relapse, consolidation therapy is usually considered in first response. Whole brain radiotherapy may prolong PFS but appears to confer no long-term survival advantage and is associated with significant neurocognitive dysfunction. Attempts to improve efficacy and reduce neurotoxicity of consolidation therapy have included thiotepa-based high-dose chemotherapy and autologous stem cell transplant (HDC-ASCT). This multi-centre, retrospective study reports the outcome of 70 patients undergoing HDC-ASCT for PCNSL in the United Kingdom. The median age at diagnosis was 56 years and all patients received HD-MTX-containing induction regimens. All patients underwent HDC-ASCT in first response. The rate of complete response increased from 50% before HDC-ASCT to 77% following HDC-ASCT. Treatment-related mortality was 6%. At a median follow-up of 12 months from HDC-ASCT, the estimated 1- and 2-year PFS rates were 71.5% and overall survival 86.4% and 83.3%, respectively. These data are comparable to published studies of HDC-ASCT for PCNSL, supporting its feasibility and efficacy.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0268-3369 1476-5365
DOI:	10.1038/bmt.2017.101