title: Upfront autologous stem-cell transplantation with melphalan, cyclophosphamide, etoposide, and dexamethasone (LEED) in patients with newly diagnosed primary central nervous system lymphoma.
abstract: Treatment of primary central nervous system lymphoma (PCNSL) improved in recent years. However, the high neurotoxicity and low survival rates associated with this condition remain unresolved. We report 13 consecutive patients with PCNSL for whom upfront melphalan, cyclophosphamide, etoposide, and dexamethasone (known as LEED) followed by autologous stem-cell transplantation (ASCT) was planned at the Anjo Kosei Hospital. All patients were pathologically diagnosed with diffuse large B-cell lymphoma and were negative for human immunodeficiency virus. All patients were to receive three cycles of high-dose methotrexate-based induction chemotherapy, two cycles of high-dose AraC-based chemotherapy, and LEED followed by ASCT. All 13 patients achieved a partial response, and the 3-year overall survival (OS) rate was 76.2 %. Seven of the 13 patients were alive at the last follow-up, without any adverse events, including neurotoxicity. Six of the 13 (46.2 %) patients underwent ASCT and the 3-year OS rate was 80.0 %. Although this study included only a limited number of patients, these preliminary signs of efficacy and tolerability merit further consideration. To make further improvements in survival, the rate of patients undergoing ASCT should be increased. Other prospective studies involving greater numbers of patients are required to confirm these findings.
authors.affiliation: Department of Hematology and Oncology, Anjo Kosei Hospital, Higashi-Hirokute 28 Anjo-Chou, Anjo, Aichi, Japan, koutarou380@yahoo.co.jp.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Miyao
authors.forename: Reona
authors.initials: R
authors.lastname: Sakemura
authors.forename: Kanae
authors.initials: K
authors.lastname: Imai
authors.forename: Toshiyasu
authors.initials: T
authors.lastname: Sakai
authors.forename: Natsuko
authors.initials: N
authors.lastname: Tsushita
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kato
authors.forename: Keiko
authors.initials: K
authors.lastname: Niimi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Ono
authors.forename: Masashi
authors.initials: M
authors.lastname: Sawa
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D016543:Central Nervous System Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D005047:Etoposide; D003907:Dexamethasone; D003520:Cyclophosphamide; D008558:Melphalan; D008727:Methotrexate