High-dose chemotherapy with autologous stem cell transplantation as first-line therapy for primary CNS lymphoma in patients younger than 60 years: a multicenter phase II study of the GOELAMS group

Abstract

The optimum treatment of primary CNS lymphoma (PCNSL) is not yet determined. The objective of this study was to assess the safety and efficacy of initial methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) in patients with newly diagnosed PCNSL. Twenty-five patients received two courses of initial chemotherapy combining methotrexate, etoposide, carmustine and methylprednisolone, and one course of ifosfamide-cytarabine followed by peripheral stem cell collection. Seventeen responsive patients then received HDT using carmustine, etoposide, cytarabine and melphalan with autologous stem cell rescue. After ASCT for responding patients or after salvage therapy for non-responders, whole brain radiation therapy at a dose of 30 Gy was delivered. The objective response rate to the induction chemotherapy was 84%. Four of the 21 responding patients did not have ASCT because of toxicity or refusal. With a median follow-up time of 34 months, the projected event free survival rate is 46% at 4 years. Projected overall survival is 64% at 4 years. Sixteen patients are actually in continuous complete response. No evidence of late treatment-related toxicity was observed. This treatment approach appears feasible in newly diagnosed PCNSL with encouraging results.

Primary central nervous system lymphoma: The role of consolidation treatment after a complete response to high‐dose methotrexate‐based chemotherapy

“…26 In addition, other clinical trials are using high-dose chemotherapy with stem cell rescue as a consolidation strategy with or without WBRT. [27][28][29][30][31][32] The role of consolidation therapy for PCNSL patients who achieved a CR after induction chemotherapy with MTX-based chemotherapy is still unclear. Long-term consequences of available consolidation strategies may outweigh the potential benefits, at least in elderly patients.…”

High-dose chemotherapy and autologous stem-cell transplantation without consolidating radiotherapy as first-line treatment for primary lymphoma of the central nervous system

“…Other studies on HDT and ASCT for first-line treatment showed 3-year OS of up to 57% without and up to 55% with consolidating WBRT. [5][6][7][8] Within this pilot phase, we doseintensified chemotherapy and restricted WBRT to patients who did not respond completely to chemotherapy to limit neurotoxicity. To determine feasibility, the percentage of patients completing the protocol and the grade of acute and late toxicity were evaluated.…”

Concomitant systemic and central nervous system non-Hodgkin lymphoma: the role of consolidation in terms of high dose therapy and autologous stem cell transplantation. A 60-case retrospective study from LYSA and the LOC network

“…In other studies, brain irradiation was systematically used after BEAM + ASCT, thus making the role of ASCT difficult to assess. 23,24 In sCNSL, BEAM and similar regimen has been used in 70 patients (46%) and TBI-based conditioning regimen in 35 patients (23%) by Marziaz et al 9 A prospective study was conducted by the HOVON group for patients in CNS relapse of an sNHL and treated with R-DHAP MTX followed by IC consisting of busulfan and cyclophosphamide. Results were disappointing with a median PFS of only six months.…”