Autologous Stem Cell Transplantation in Central Nervous System Lymphoma: A Multicenter Retrospective Series and a Review of the Literature

Bhagirathbhai R. Dholaria, Ambuj Kumar, Abdel Ghani Azzuqua, Taiga Nishihori, Mohamed A. Kharfan-Dabaja, Han W Tun, Ernesto Ayala

Research output: Contribution to journalArticle

Abstract

Background: Central 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 Methods: We 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. Results: The 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. Conclusion: In 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.

Original languageEnglish (US)
JournalClinical Lymphoma, Myeloma and Leukemia
DOIs
StatePublished - Jan 1 2019

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Stem Cell Transplantation
Lymphoma
Central Nervous System
Confidence Intervals
Recurrence
Disease-Free Survival
Thiotepa
Carmustine
Survival
Methotrexate
Retrospective Studies
Drug Therapy
Mortality
Incidence

Keywords

  • Non-relapse mortality
  • Overall survival
  • Primary central nervous system lymphoma
  • Relapse/progression
  • Secondary central nervous system lymphoma

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Autologous Stem Cell Transplantation in Central Nervous System Lymphoma : A Multicenter Retrospective Series and a Review of the Literature. / Dholaria, Bhagirathbhai R.; Kumar, Ambuj; Azzuqua, Abdel Ghani; Nishihori, Taiga; Kharfan-Dabaja, Mohamed A.; Tun, Han W; Ayala, Ernesto.

In: Clinical Lymphoma, Myeloma and Leukemia, 01.01.2019.

Research output: Contribution to journalArticle

Dholaria, Bhagirathbhai R. ; Kumar, Ambuj ; Azzuqua, Abdel Ghani ; Nishihori, Taiga ; Kharfan-Dabaja, Mohamed A. ; Tun, Han W ; Ayala, Ernesto. / Autologous Stem Cell Transplantation in Central Nervous System Lymphoma : A Multicenter Retrospective Series and a Review of the Literature. In: Clinical Lymphoma, Myeloma and Leukemia. 2019.
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abstract = "Background: Central 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 Methods: We 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. Results: The 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. Conclusion: In 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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AU - Kumar, Ambuj

AU - Azzuqua, Abdel Ghani

AU - Nishihori, Taiga

AU - Kharfan-Dabaja, Mohamed A.

AU - Tun, Han W

AU - Ayala, Ernesto

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AB - Background: Central 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 Methods: We 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. Results: The 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. Conclusion: In 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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