title: Prognosis of patients with primary central nervous system lymphoma after high-dose chemotherapy followed by autologous stem cell transplantation.
abstract: High-dose chemotherapy followed by autologous stem cell transplantation has been shown to be feasible and highly effective in newly diagnosed primary central nervous system lymphoma. In this retrospective multicenter study, we investigated prognosis and baseline risk factors in patients with primary central nervous system lymphoma who underwent this treatment approach. We retrospectively analyzed 105 immunocompetent patients with primary central nervous system lymphoma who underwent high-dose chemotherapy followed by autologous stem cell transplantation with or without whole brain radiotherapy as first-line consolidation treated at 12 German centers between 1997 and 2011. We estimated survival rates and investigated the impact of age, performance status, serum lactate dehydrogenase level, and deep brain involvement on overall and progression-free survival. Patients were additionally categorized into three prognostic groups according to the Memorial Sloan Kettering Cancer Center prognostic model. After a median follow up of 47 months, median progression-free survival and overall survival was reached after 85 and 121 months; 2- and 5-year survival rates were 82% and 79%, respectively. The Memorial Sloan Kettering Cancer Center prognostic model did not predict survival. Only age revealed some evidence of prognostic relevance. Overall response rate was 95%; of those patients with progressive disease before high-dose chemotherapy, 7 of 20 achieved ongoing complete remission after therapy without whole brain radiation therapy. Transplantation-associated mortality was 2.8%. High-dose chemotherapy followed by autologous stem cell transplantation is a highly effective and safe treatment modality for selected primary central nervous system lymphoma patients. Superiority compared to standard chemotherapy still warrants further investigation.
authors.affiliation: Department of Hematology/Oncology, Freiburg University Medical Center, Freiburg, Germany.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schorb
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kasenda
authors.forename: Johannes
authors.initials: J
authors.lastname: Atta
authors.forename: Stephan
authors.initials: S
authors.lastname: Kaun
authors.forename: Anke
authors.initials: A
authors.lastname: Morgner
authors.forename: Georg
authors.initials: G
authors.lastname: Hess
authors.forename: Thomas
authors.initials: T
authors.lastname: Elter
authors.forename: Nikolas
authors.initials: N
authors.lastname: von Bubnoff
authors.forename: Martin
authors.initials: M
authors.lastname: Dreyling
authors.forename: Mark
authors.initials: M
authors.lastname: Ringhoffer
authors.forename: Stefan W
authors.initials: SW
authors.lastname: Krause
authors.forename: Günter
authors.initials: G
authors.lastname: Derigs
authors.forename: Beate
authors.initials: B
authors.lastname: Klimm
authors.forename: D
authors.initials: D
authors.lastname: Niemann
authors.forename: Kristina
authors.initials: K
authors.lastname: Fritsch
authors.forename: Jürgen
authors.initials: J
authors.lastname: Finke
authors.forename: Gerald
authors.initials: G
authors.lastname: Illerhaus
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000401:mortality* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008223:Lymphoma / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011878:Radiotherapy; D012189:Retrospective Studies; D012307:Risk Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents