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Role of upfront autologous stem cell transplantation in patients newly diagnosed with primary CNS lymphoma treated with R-MVP: real-world data from a retrospective single-center analysis

Bone Marrow Transplantation volume 57, pages 641–648 (2022)Cite this article

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Abstract

The role of upfront autologous stem cell transplantation (ASCT) remains unclear in patients with primary central nervous system lymphoma (PCNSL) receiving rituximab and high-dose methotrexate (MTX)-based chemotherapy. We analyzed the outcomes of upfront ASCT in 106 patients with PCNSL (median age, 64 years; range, 34–86) who received rituximab, MTX, vincristine, and prednisolone (R-MVP). The objective response rate was 88.7% (94/106) and included 46 complete responses (43.4%). Upfront ASCT was performed in 38 responders (median age, 51 years; range, 34–69), including 13 patients aged >60 years, after conditioning with busulfan (3.2 mg/kg, days 8 to 5) and thiotepa (5 mg/kg, days 4–3). For 56 responders ineligible for ASCT because of age >70 years, poor performance status, or refusal to undergo upfront ASCT, other consolidation treatments (n = 32) or observation (n = 24) were performed. With a median follow-up of 24.4 months (95% confidence interval, 20.7–28.0 months), no transplantation-related deaths occurred and seven patients relapsed after upfront ASCT. By contrast, 24 relapses occurred in patients who did not receive upfront ASCT. The progression-free and overall survival were significantly better in patients undergoing upfront ASCT (P = 0.001). Our real-world data suggest the benefit from upfront ASCT.

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Fig. 1: The clinical course of patients who received R-MVP followed by upfront ASCT or other consolidation treatments.
Fig. 2: The impact of upfront ASCT on the survival outcomes of patients with PCNSL.
Fig. 3: The analysis of survival outcomes.
Fig. 4: The targeted sequencing of tumor tissue and survival outcomes.

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DATA AVAILABILITY

All data are available upon request from the corresponding author.

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Acknowledgements

This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) from the Ministry of Health & Welfare, Republic of Korea (grant number: HR20C0025) and by a National Research Foundation of Korea (NRF) grant from the Korean government (2021R1A2C1007531). No companies supported this study.

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Authors and Affiliations

  1. Division of Hematology-oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Sang Eun Yoon, Hyunji Jo, Won Seog Kim & Seok Jin Kim

  2. Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Eun-Suk Kang & Duck Cho

  3. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Junhun Cho

  4. Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea

    Won Seog Kim & Seok Jin Kim

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Contributions

SJK and. SEY conceived and designed the study. SEY, ESK, DC, JC, WSK, and SJK enrolled patients in the study and collected clinical data. SJK and. SEY analyzed the data and wrote the manuscript. All authors edited the manuscript and approved the final version of the manuscript.

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Correspondence to Seok Jin Kim.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of Samsung Medical Center (approval number. 2016-11-040-019). It was conducted in accordance with the ethical principles of the Declaration of Helsinki and the Korea Good Clinical Practice guidelines.

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Yoon, S.E., Jo, H., Kang, ES. et al. Role of upfront autologous stem cell transplantation in patients newly diagnosed with primary CNS lymphoma treated with R-MVP: real-world data from a retrospective single-center analysis. Bone Marrow Transplant 57, 641–648 (2022). https://doi.org/10.1038/s41409-022-01605-w

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