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Putting caution in TEAM: high-dose chemotherapy with autologous HSCT for primary central nervous system lymphoma

Bone Marrow Transplantation volume 47, pages 1383–1384 (2012)Cite this article

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We read with great interest the recent manuscript on treatment of primary central nervous system lymphoma (PCNSL) with high-dose chemotherapy followed by autologous hematopoietic SCT.1 The authors highlight several important issues regarding the difficulties with treating this disease. Indeed, a recent review of clinical experience with PCNSL concluded that high-dose chemotherapy±whole-brain radiotherapy followed by autologous HSCT holds promise to improve patient outcomes.2 Although this latest review of PCNSL is thought-provoking, we find discrepancies that may confound the authors’ conclusions.

As acknowledged by the authors, there is a great heterogeneity of both induction and conditioning regimens employed in studies for newly-diagnosed PCNSL.2 Bearing in mind not only the variations in chemotherapy regimens, but also the variations of survival seen in these studies, we are surprised to find the authors’ conclusion of superiority with ‘thiotepa/busulfan based conditioning’ and recommendation of this strategy as a ‘suggested treatment approach in patients with PCNSL’.1 Although these two agents may have a role in conditioning for autologous HSCT to treat newly-diagnosed PCNSL, the scarcity of data makes their role ill-defined.2 The majority of conditioning regimens employed in studies on newly-diagnosed PCNSL do not contain thiotepa and fewer still contain BU.2 The total number of patients with newly-diagnosed PCNSL who had received a BU and thiotepa-based conditioning regimen before autologous HSCT was 53, a number far too small to use as the basis for an algorithm for the treatment of newly-diagnosed PCNSL patients.3, 4, 5

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Authors and Affiliations

  1. Department of Pharmacy Services, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA

    R L Tombleson

  2. Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA

    R L Tombleson

  3. Section of Blood and Marrow Transplantation, University of Arizona Cancer Center, Tucson, AZ, USA

    M R Green

  4. Department of Pharmacy Services, University of Arizona Medical Center, Tucson, AZ, USA

    M R Green

  5. West Penn Allegheny Oncology Network, Pittsburgh, PA, USA

    K M Fancher

  6. The Western Pennsylvania Hospital Outpatient Services, Pittsburgh, PA, USA

    K M Fancher

Authors
  1. R L Tombleson
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  2. M R Green
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  3. K M Fancher
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Correspondence to R L Tombleson.

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Tombleson, R., Green, M. & Fancher, K. Putting caution in TEAM: high-dose chemotherapy with autologous HSCT for primary central nervous system lymphoma. Bone Marrow Transplant 47, 1383–1384 (2012). https://doi.org/10.1038/bmt.2012.48

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