1. ¹Hématologie, CHU Tours, France
2. ²Hématologie, CAC Gauducheau, Nantes, France
3. ³Département de Statistiques, CHU Tours, France
4. ⁴Hématologie, CHU Poitiers, France
5. ⁵Hématologie, CHU Angers, France
6. ⁶Hématologie – CHU Besançon, France
7. ⁷Hématologie, CHU Brest, France
8. ⁸Hématologie – Centre Jean Perrin, Clermont-Ferrand, France
9. ⁹Attaché de Recherche Clinique, GOELAMS, France
10. ¹⁰Hématologie, CHU Amiens, France
11. ¹¹Laboratoire Anatomopathologie, CHU Hôtel Dieu, Paris, France
12. ¹²Oncologie Médicale, CHU Tours, France
13. ¹³Hématologie, CHU Rennes, France

Correspondence: PH Colombat, Department of Haematology, CHU TOURS – 37044 TOURS Cedex, France. E-mail: colombat@med.univ-tours.fr

Received 11 April 2006; Revised 8 June 2006; Accepted 13 June 2006.

Abstract

The optimum treatment of primary CNS lymphoma (PCNSL) is not yet determined. The objective of this study was to assess the safety and efficacy of initial methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) in patients with newly diagnosed PCNSL. Twenty-five patients received two courses of initial chemotherapy combining methotrexate, etoposide, carmustine and methylprednisolone, and one course of ifosfamide–cytarabine followed by peripheral stem cell collection. Seventeen responsive patients then received HDT using carmustine, etoposide, cytarabine and melphalan with autologous stem cell rescue. After ASCT for responding patients or after salvage therapy for non-responders, whole brain radiation therapy at a dose of 30 Gy was delivered. The objective response rate to the induction chemotherapy was 84%. Four of the 21 responding patients did not have ASCT because of toxicity or refusal. With a median follow-up time of 34 months, the projected event free survival rate is 46% at 4 years. Projected overall survival is 64% at 4 years. Sixteen patients are actually in continuous complete response. No evidence of late treatment-related toxicity was observed. This treatment approach appears feasible in newly diagnosed PCNSL with encouraging results.