Improving the outcomes of secondary CNS lymphoma with high-dose thiotepa, busulfan, melphalan, rituximab conditioning and autotransplant

Abstract

Secondary central nervous system lymphoma (SCNSL) affects approximately 5% of patients with aggressive large B-cell lymphoma (LBCL) and is associated with poor outcomes. This retrospective, multicenter study included 62 consecutive patients with SCNSL intended for transplant with high-dose methotrexate (HD-MTX)-based induction followed by high-dose thiotepa, busulfan, melphalan, rituximab (TBMR) conditioning and autologous stem cell transplantation (ASCT). Median age was 58 years (range 20–75) and 52 (84%) patients had ECOG performance status >1 at diagnosis of SCNSL. Fifty-two (84%) patients completed induction and proceeded to TBMR/ASCT. With median follow-up 5.7 years, 5-year progression-free and overall survival rates were 53% (95% CI 39–65%) and 65% (95% CI 51–76%) for all patients and 62% (95% CI 45–74%) and 73% (95% CI 57–84%) for those undergoing TBMR/ASCT, respectively. Despite a historically poor prognosis, HD-MTX-based induction followed by TBMR/ASCT has the potential to achieve long-term survival in a substantial proportion of patients with SCNSL.

Keywords:

• Diffuse large B-cell lymphoma
• CNS relapse
• secondary CNS lymphoma
• autologous stem cell transplantation

Informed consent

Consent is not required for this type of retrospective study as it poses minimal risk to participants.

Ethics approval

This study was approved by the Health Research Ethics Board of Alberta.

Author contributions

RP designed the study, conducted research, and wrote the manuscript. DS designed the study, interpreted data, and wrote the manuscript. NC and MS interpreted data and wrote the manuscript.

Disclosure statement

RP and MS have no conflicts of interest to disclose. NC has received honoraria from Eisai, Gilead, Merck, and Pfizer. DS has received honoraria from Abbvie, AstraZeneca, Amgen, Celgene, Gilead, Janssen, Novartis, Roche, Sandoz, and Teva.