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Lymphoma

High-dose chemotherapy with autologous haematopoietic stem cell support for relapsed or refractory primary CNS lymphoma: a prospective multicentre trial by the German Cooperative PCNSL study group

Leukemia volume 31, pages 2623–2629 (2017)Cite this article

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Abstract

To investigate safety and efficacy of high-dose chemotherapy followed by autologous stem cell transplantation (HCT-ASCT) in relapsed/refractory (r/r) primary central nervous system lymphoma (PCNSL), we conducted a single-arm multicentre study for immunocompetent patients (<66 years) with PCNSL failing high-dose methotrexate)-based chemotherapy. Induction consisted of two courses of rituximab (375 mg/m2), high-dose cytarabine (2 × 3 g/m2) and thiotepa (40 mg/m2) with collection of stem cells in between. Conditioning for HCT-ASCT consisted of rituximab 375 mg/m2, carmustine 400 mg/m2 and thiotepa (4 × 5 mg/kg). Patients commenced HCT-ASCT irrespective of response after induction. Patients not achieving complete remission (CR) after HCT-ASCT received whole-brain radiotherapy. Primary end point was CR after HCT-ASCT. We enrolled 39 patients; median age and Karnofsky performance score are 57 years and 90%, respectively. About 28 patients had relapsed and 8 refractory disease. About 22 patients responded to induction and 32 patients commenced HCT-ASCT. About 22 patients (56.4%) achieved CR after HCT-ASCT. Respective 2-year progression-free survival (PFS) and overall survival (OS) rates were 46.0% (median PFS 12.4 months) and 56.4%; median OS not reached. We recorded four treatment-related deaths. Thiotepa-based HCT-ASCT is an effective treatment option in eligible patients with r/r PCNSL. Comparative studies are needed to further scrutinise the role of HCT-ASCT in the salvage setting.

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Acknowledgements

Role of the funding source

The trial was sponsored by the Freiburg University Hospital. Amgen provided additional financial support. Decision for publication was solely made by the academic investigators.

Author information

Author notes

  1. J Finke and G Illerhaus: These two authors contributed equally to this work.

Authors and Affiliations

  1. Department of Haematology/Oncology, Klinikum Stuttgart, Stuttgart, Germany

    B Kasenda, E Valk & G Illerhaus

  2. Department of Medical Oncology & Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland

    B Kasenda

  3. Clinical Trials Unit, Medical Centre - University of Freiburg, Freiburg, Germany

    G Ihorst

  4. Department of Medicine, Hematology and Oncology, Ruhr-University of Bochum, Knappschaftskrankenhaus Bochum-Langendreer, Bochum, Germany

    R Schroers

  5. Department of Hematology, Oncology and Tumor Immunology, Charite University Medicine, Berlin, Germany

    A Korfel

  6. Department of Internal Medicine III, Center for Integrated Oncology (CIO), University Hospital Bonn, Bonn, Germany

    I Schmidt-Wolf

  7. Department of Haematology and Oncology, Heidelberg University, Heidelberg, Germany

    G Egerer

  8. Department of Neurology, University Hospital Munich LMU, Munich, Germany

    L von Baumgarten

  9. Department of Haematology, Medical Faculty, University of Duisburg-Essen, Essen, Germany

    A Röth

  10. Department of Internal Medicine III, University of Ulm, Ulm, Germany

    J Bloehdorn

  11. Department of Haematology and Oncology, University Tübingen, Tübingen,, Germany

    R Möhle

  12. Department of Oncology and Hematology, University of Hamburg, Hamburg, Germany

    M Binder

  13. III Medical Department, Technische Universität München, Munich, Germany

    U Keller

  14. Department of Internal Medicine II, University Hospital of Schleswig-Holstein, Campus Kiel, Germany

    M Lamprecht

  15. Klinik für Innere Medizin I, Universität des Saarlandes, Homburg, Germany

    M Pfreundschuh

  16. Department of Haematology, Oncology and Stem Cell Transplantation, University Hospital Freiburg, Freiburg, Germany

    H Fricker, E Schorb, K Fritsch, J Finke & G Illerhaus

Authors
  1. B Kasenda
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Corresponding author

Correspondence to G Illerhaus.

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Competing interests

AK discloses honoraria from PIQUR, Mundipharama and Riemser, research funding from Mundipharma and Riemser, and travel support from PIQUR, Mundipharama and Riemser. AR discloses consultancy activities for Novartis and Roche. ES discloses travel support from Amgen, Janssen and Baxter. GI discloses honoraria from Riemser, consultancies for Celgene, travel support from Roche, BMS and Roche. JF discloses travel support from Riemser and Medac. MB discloses honoraria from Hexal Biosimilars, Sanofi and MSD, consulting activities for BMS, Roche, Hexal Biosimilars, Takeda, and travel support by Takeda, Gilead and Hexal Biosimilars. RS discloses travel support from Celgene, Janssen and Sanofi. UK discloses stock ownership of Kite Pharmaceuticals, consulting activities for Roche, BMS; Janssen, MSD, Merck, Gilead and Takeda, being part of speaker’s bureau of Gilead and travel support by Roche, BMS and Takeda. The remaining authors declare no conflict of interest.

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Kasenda, B., Ihorst, G., Schroers, R. et al. High-dose chemotherapy with autologous haematopoietic stem cell support for relapsed or refractory primary CNS lymphoma: a prospective multicentre trial by the German Cooperative PCNSL study group. Leukemia 31, 2623–2629 (2017). https://doi.org/10.1038/leu.2017.170

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