title: Autologous stem cell transplant in recurrent or refractory primary or secondary central nervous system lymphoma using thiotepa, busulfan and cyclophosphamide.
abstract: The prognosis for patients with central nervous system (CNS) involvement by recurrent or refractory diffuse large B-cell lymphoma is poor, with overall survival (OS) of 4-10 months. High-dose chemotherapy (HDC) and autologous stem cell transplant (ASCT) is a potential treatment alternative. We reviewed patients with recurrent primary (PCNSL) or secondary (SCNSL) CNS lymphoma referred for consolidation HDC-ASCT utilizing thiotepa, busulfan and cyclophosphamide (TBC). Among the 17 patients included, all had achieved a complete remission after salvage induction chemotherapy, which incorporated methotrexate in 82% of patients. Two patients failed stem-cell harvesting and 15 (88%) underwent transplant. The estimated 3-year progression-free survival (PFS) and OS were both 93% (95% confidence interval 61-99%). Median PFS and OS were not reached. There was no transplant-related mortality. These results confirm the benefit of TBC followed by ASCT in select patients with recurrent PCNSL and suggest a potential role for the regimen in those with SCNSL. Further investigation is warranted.
authors.affiliation: Department of Neurology, Memorial Sloan-Kettering Cancer Center , New York, NY , USA.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Welch
authors.forename: Craig S
authors.initials: CS
authors.lastname: Sauter
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Matasar
authors.forename: Geraldine
authors.initials: G
authors.lastname: Faivre
authors.forename: Susan A
authors.initials: SA
authors.lastname: Weaver
authors.forename: Craig H
authors.initials: CH
authors.lastname: Moskowitz
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Omuro
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002066:Busulfan / Q000008:administration & dosage; D016543:Central Nervous System Neoplasms / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012074:Remission Induction; D033581:Stem Cell Transplantation / Q000379:methods*; D013852:Thiotepa / Q000008:administration & dosage; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D003520:Cyclophosphamide; D013852:Thiotepa; D002066:Busulfan
keywords: Central nervous system lymphoma; autologous stem cell transplant; chemotherapeutic approaches; high-dose chemotherapy; stem cell mobilization