title: Promising treatment results with blood brain barrier disruption (BBBD) based immunochemotherapy combined with autologous stem cell transplantation (ASCT) in patients with primary central nervous system lymphoma (PCNSL).
abstract: Primary central nervous system lymphoma (PCNSL) is a rare brain tumour with a dismal prognosis. Several phase II studies with high-dose methotrexate-based regimens have shown promising early results, but in all hospital-based data published so far, the disease outcome has been poor. Patients with relapsed or refractory disease have a dismal prognosis. We performed retrospective analysis to evaluate results and tolerabilities of BBBD therapy in combination with high-dose therapy supported by autologous stem cell transplantation. We analysed 25 patients (age range: 40-71 years) who were treated in first or second line with BBBD therapy. When we started BBBD treatment, patients had relapsed or refractory PCNSL or they did not tolerate Bonn-like therapy. In recent years, some of the patients were treated in first line. We found promising response rates. Altogether 19 (76 %) of the patients achieved a complete response (CR). Two-year progression-free survival (PFS) and overall survival (OS) rates were 61 and 57 % respectively and the five-year OS was 47 %. Patients who were treated with a five-drug therapy had a very promising prognosis. The CR rate was 100 % in first-line therapy and 60 % in relapsed cases. These findings suggest that BBBD is a promising therapy for PCNSL, especially for patients in first line, but also for patients with relapsed or refractory disease after conventional chemotherapy, who commonly have a very poor prognosis. Treatment-related toxicity was generally manageable. Thus, BBBD followed by ASCT could be a treatment of choice in transplant-eligible patients with PCNSL.
authors.affiliation: Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu University, Kajaanintie 50, P.O. Box 5000, 90014, Oulu, Finland. hanne.kuitunen@ppshp.fi.
authors.forename: Hanne
authors.identifier: 0000-0001-7328-2043
authors.initials: H
authors.lastname: Kuitunen
authors.affiliation: Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu University, Kajaanintie 50, P.O. Box 5000, 90014, Oulu, Finland.
authors.forename: Susanna
authors.initials: S
authors.lastname: Tokola
authors.affiliation: Department of Radiology, Oulu University Hospital, Oulu University, Oulu, Finland.
authors.forename: Topi
authors.initials: T
authors.lastname: Siniluoto
authors.affiliation: Department of Radiology, Oulu University Hospital, Oulu University, Oulu, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Isokangas
authors.affiliation: Department of Anaesthesiology, Oulu University Hospital, Oulu University, Oulu, Finland.
authors.forename: Eila
authors.initials: E
authors.lastname: Sonkajärvi
authors.affiliation: Department of Anaesthesiology, Oulu University Hospital, Oulu University, Oulu, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Alahuhta
authors.affiliation: Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu University, Kajaanintie 50, P.O. Box 5000, 90014, Oulu, Finland.
authors.forename: Taina
authors.initials: T
authors.lastname: Turpeenniemi-Hujanen
authors.affiliation: Department of Medicine Kuopio, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Jantunen
authors.affiliation: Department of Medicine Kuopio, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Tapio
authors.initials: T
authors.lastname: Nousiainen
authors.affiliation: Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland.
authors.forename: Kaija
authors.initials: K
authors.lastname: Vasala
authors.affiliation: Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu University, Kajaanintie 50, P.O. Box 5000, 90014, Oulu, Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Kuittinen
mesh_terms: D000328:Adult; D000368:Aged; D000074322:Antineoplastic Agents, Immunological / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D001812:Blood-Brain Barrier / Q000378:metabolism*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D000074322:Antineoplastic Agents, Immunological
keywords: BBBD therapy; Primary central nervous system lymphoma; Prognosis