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Lymphoma

High-dose chemotherapy and autologous stem cell transplantation for primary central nervous system lymphoma: a multi-centre retrospective analysis from the United Kingdom

Bone Marrow Transplantation volume 52, pages 1268–1272 (2017)Cite this article

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Abstract

The prognosis of patients with primary central nervous system lymphoma (PCNSL) has improved in recent years. This has partly been achieved by remission induction protocols incorporating high-dose methotrexate (HD-MTX) and rituximab. Given the high rates of relapse, consolidation therapy is usually considered in first response. Whole brain radiotherapy may prolong PFS but appears to confer no long-term survival advantage and is associated with significant neurocognitive dysfunction. Attempts to improve efficacy and reduce neurotoxicity of consolidation therapy have included thiotepa-based high-dose chemotherapy and autologous stem cell transplant (HDC-ASCT). This multi-centre, retrospective study reports the outcome of 70 patients undergoing HDC-ASCT for PCNSL in the United Kingdom. The median age at diagnosis was 56 years and all patients received HD-MTX-containing induction regimens. All patients underwent HDC-ASCT in first response. The rate of complete response increased from 50% before HDC-ASCT to 77% following HDC-ASCT. Treatment-related mortality was 6%. At a median follow-up of 12 months from HDC-ASCT, the estimated 1- and 2-year PFS rates were 71.5% and overall survival 86.4% and 83.3%, respectively. These data are comparable to published studies of HDC-ASCT for PCNSL, supporting its feasibility and efficacy.

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Acknowledgements

We thank the patients and the staff that looked after them. We also acknowledge members of the UK PCNSL working party and the support of the NCRI lymphoma CSG.

Author contributions

SK, KC and CPF provided patients, collected and analysed the data, performed statistical analysis and wrote the paper. EC, AO’N, CH, TC, AD, SM, AL, GA, KM, PM, DD, CR, SE, TAE and RM provided patients and collected data.

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Authors and Affiliations

  1. Department of Haematology, King’s College Hospital, London, UK

    S Kassam & R Marcus

  2. Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK

    E Chernucha & C P Fox

  3. Department of Haematology, University College Hospital, London, UK

    A O’Neill & K Cwynarski

  4. Department of Haematology, Barking, Havering and Redbridge University Hospitals, Essex, UK

    C Hemmaway

  5. Department of Haematology, University Hospital Southampton, Southampton, UK

    T Cummins

  6. Department of Haematology, Barts Health NHS Trust, London, UK

    S Montoto

  7. Department of Haematology, Freeman Hospital, Newcastle, UK

    A Lennard

  8. Department of Haematology, Hammersmith Hospital, London, UK

    G Adams

  9. Department of Haematology, The Christie NHS Foundation Trust, Manchester, UK

    K Linton

  10. Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK

    P McKay

  11. Department of Haematology, University Hospital of Wales, Cardiff

    D Davies & C Rowntree

  12. Department of Haematology, The Royal Marsden Hospital, Sutton, UK

    S Easdale

  13. Department of Haematology, Churchill Hospital, Oxford, UK

    T A Eyre

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  1. S Kassam
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  2. E Chernucha
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  3. A O’Neill
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  4. C Hemmaway
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  5. T Cummins
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  6. S Montoto
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  7. A Lennard
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  8. G Adams
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  9. K Linton
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  10. P McKay
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  11. D Davies
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  12. C Rowntree
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  13. S Easdale
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  14. T A Eyre
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  15. R Marcus
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  16. K Cwynarski
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  17. C P Fox
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Corresponding author

Correspondence to S Kassam.

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Competing interests

SK has received travel support from Gilead and a research grant from Celgene. CPF has received speaker honoraria and advisory board remuneration from Adienne Pharma/Biotech and Roche. KC has received speaker honoraria and advisory board remuneration from Adienne and Roche. SM received speaker honoraria from Roche and travel support from Gilead. All other authors declare no conflicts of interest.

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Kassam, S., Chernucha, E., O’Neill, A. et al. High-dose chemotherapy and autologous stem cell transplantation for primary central nervous system lymphoma: a multi-centre retrospective analysis from the United Kingdom. Bone Marrow Transplant 52, 1268–1272 (2017). https://doi.org/10.1038/bmt.2017.101

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