Intensive chemotherapy followed by hematopoietic stem-cell rescue for refractory and recurrent primary CNS and intraocular lymphoma: Société Française de Greffe de Moëlle Osseuse-Thérapie Cellulaire.
OBJECTIVE
The prognosis of relapsing primary CNS lymphoma (PCNSL) is poor. We report the results of a prospective multicenter trial of intensive chemotherapy followed by autologous hematopoietic stem-cell rescue (IC + HCR) in immunocompetent adult patients with PCNSL or intraocular lymphoma (IOL) after failure of high-dose methotrexate-based treatment.


METHODS
Salvage treatment consisted of two cycles of high-dose cytarabine and etoposide (CYVE). Intensive chemotherapy combined thiotepa, busulfan, and cyclophosphamide. Forty-three patients (median age, 52 years; range, 23 to 65 years) were included, with relapse (n = 22), refractory disease (n = 17), or a partial response to first-line treatment (n = 4). The response to CYVE was not assessable in three cases because of treatment-related death. Twenty patients (47%) were chemosensitive to CYVE: 15 of them proceeded to IC + HCR. IC + HCR was also administered to 12 patients who did not respond to CYVE. All but one of the 27 patients who underwent IC + HCR entered complete remission.


RESULTS
With a median follow-up of 36 months, the median overall survival was 18.3 months in the overall population, and 58.6 months among patients who completed IC + HCR. The respective median progression-free survival (PFS) times after IC + HCR were 11.6 and 41.1 months. The 2-year overall survival probability was 45% in the whole population and 69% among the 27 patients who received IC + HCR. The 2-year PFS probability was 43% among all the patients and 58% in the IC + HCR subpopulation.


CONCLUSIONS
IC + HCR is an effective treatment for refractory and recurrent PCNSL.
Soussain
Carole
C
Department of Hematology, Biostatistics Unit, Centre René Huguenin, Saint-Cloud, France. soussain@crh1.org
Hoang-Xuan
Khê
K
Taillandier
Luc
L
Fourme
Emmanuelle
E
Choquet
Sylvain
S
Witz
Francis
F
Casasnovas
Olivier
O
Dupriez
Brigitte
B
Souleau
Bertrand
B
Taksin
Anne-Laure
AL
Gisselbrecht
Christian
C
Jaccard
Arnaud
A
Omuro
Antonio
A
Sanson
Marc
M
Janvier
Maud
M
Kolb
Brigitte
B
Zini
Jean-Marc
JM
Leblond
Véronique
V
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000628:therapy*; D002066:Busulfan / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005134:Eye Neoplasms / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000628:therapy*; D011446:Prospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D013852:Thiotepa / Q000008:administration & dosage
D003561:Cytarabine; D005047:Etoposide; D003520:Cyclophosphamide; D013852:Thiotepa; D002066:Busulfan