Effectiveness and safety of thiotepa as conditioning treatment prior to stem cell transplant in patients with central nervous system lymphoma.
BACKGROUND
Thiothepa is a cytostatic agent used in managing solid malignancies, and also as conditioning treatment before hematopoietic stem cell transplantation [HSCT]. This systematic review summarizes evidence on its effectiveness and safety, in patients with central nervous system [CNS] lymphoma.


METHODS
We searched 3 databases for clinical studies. When feasible, we performed meta-analyses.


RESULTS
We identified 13 eligible studies, none of which with a priori controls. So data synthesis focused on the 226 patients who received thiotepa. Based on pooled estimates, 75.9% of thiotepa-treated patients achieved a complete remission (95% confidence interval [CI] = 67.5-82.8), and 61.7% had a progression-free survival for up to 125 months post-treatment (95% CI = 49.4-72.7). However, 25.5% relapsed, 24.6% experienced infection, and 13.2% experienced neurotoxicity.


CONCLUSIONS
Thiotepa-based conditioning followed by HSCT may be effective in most CNS lymphoma patients, with a manageable toxicity profile. But adequately powered randomized trials are needed to better evaluate and isolate the effects of thiotepa.
Ottawa Hospital Research Institute , Ottawa, Ontario , Canada.
Madzouka B
MB
Kokolo
Dean
D
Fergusson
Joseph
J
O'Neill
Jason
J
Tay
Alan T
AT
Tinmouth
Douglas
D
Stewart
Chris
C
Bredeson
D016543:Central Nervous System Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008223:Lymphoma / Q000150:complications / Q000473:pathology / Q000628:therapy*; D019653:Myeloablative Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local; D017594:Publication Bias; D013852:Thiotepa / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019172:Transplantation Conditioning; D016896:Treatment Outcome
D019653:Myeloablative Agonists; D013852:Thiotepa
Clinical results; infectious complications; lymphoma and Hodgkin disease; stem cell mobilization; transplant toxicity