High-dose therapy with hematopoietic cell transplantation for patients with central nervous system involvement by non-Hodgkin's lymphoma

Abstract

Central nervous system (CNS) involvement by non-Hodgkin's lymphoma (NHL) carries a poor patient prognosis whether it occurs as a primary site of disease or secondarily in patients with systemic disease. In a group of 481 patients undergoing high-dose therapy with hematopoietic cell transplantation (HCT) for NHL, 15 patients (3.1%) were identified with CNS involvement. Two patients had primary CNS lymphoma, and 13 had secondary disease. All patients received intrathecal chemotherapy, and 13 received CNS radiotherapy before transplantation. Fourteen patients received systemic chemotherapy. At the time of transplantation, both patients with primary CNS lymphoma and 8 patients with secondary disease had achieved a complete response, 3 patients had achieved a partial response, 1 had failed induction therapy, and 1 had progression of CNS disease before high-dose therapy. Fourteen patients received carmustine, etoposide, and cyclophosphamide as the preparative regimen, and 1 patient received fractionated total body irradiation instead of carmustine. The 2 patients with primary CNS lymphoma were alive and free of disease, 1 at 1,085 days after HCT and 1 at 3,704 days after HCT. The actuarial 5-year event-free survival (EFS) was 46% +/- 26%, and overall survival (OS) was 41% +/- 28%. The median EFS and OS were 2.2 and 1.5 years, respectively. Three patients experienced symptomatic memory loss or intellectual decline after therapy, 1 patient developed paraplegia, and 1 patient had a thrombotic stroke 20 months after HCT. Despite treatment-related toxicities, 7 patients responding to quality-of-life questions at approximately 1 year after HCT gave their overall quality of life a median rating of 9 out of a possible 10 (range, 6-10). High-dose therapy with autologous HCT can produce extended EFS in patients with secondary CNS lymphoma and possibly in those with primary CNS NHL.

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

“…This study provided sNHL data mainly at relapse. 5,6,[11][12][13][14] Systemic lymphoma with CNS localization haematologica | 2015; 100 (9) 1203 …”

“…This strategy and the best intensive chemotherapy regimen remain to be validated in prospective trials. Anne Parcelier, 2 Wajed Abarah, 7 Zora Marjanovic, 8 Rémy Gressin, 9 Reda Garidi, 10 Momar Diouf, 10 Anne-Claire Gac, 1 Jehan Dupuis, 12 Xavier Troussard, 1 Franck Morschhauseur, 13 Hervé Ghesquières, 14 and Carole Soussain 15,16 on behalf of the LYSA and LOC network, France to report on the therapeutic characteristics of these patients as well as on the role of high-dose therapy and autologous stem cell transplantation in these settings.…”

Phase II study of central nervous system (CNS)-directed chemotherapy including high-dose chemotherapy with autologous stem cell transplantation for CNS relapse of aggressive lymphomas

“…16,17 Small retrospective analyses have revealed long-term remissions in some patients treated with HD-ASCT for SCNSL. [18][19][20] In a single institution retrospective analysis of 43 patients with SCNSL, long-term survival was found only in those treated with HD-ASCT. 11 Here, we present the first completed prospective multicenter study to evaluate feasibility and efficacy of HD-ASCT in patients with SCNSL.…”

Systemic high-dose methotrexate plus ifosfamide is highly effective for central nervous system (CNS) involvement of lymphoma

“…In particular, subsequent treatment with highdose chemotherapy and autologous stem cell transplantation in five patients might have contributed to the favorable overall survival. High-dose chemotherapy with stem-cell transplantation is the only treatment associated with prolonged survival in patients with CNS involvement of aggressive lymphomas [25,26]. WBI alone may represent an effective salvage treatment for many PCNSL patients [27].…”