Effectiveness and safety of thiotepa as conditioning treatment prior to stem cell transplant in patients with central nervous system lymphoma

Abstract

Background. Thiothepa is a cytostatic agent used in managing solid malignancies, and also as conditioning treatment before hematopoietic stem cell transplantation [HSCT]. This systematic review summarizes evidence on its effectiveness and safety, in patients with central nervous system [CNS] lymphoma. Methods. We searched 3 databases for clinical studies. When feasible, we performed meta-analyses. Results. We identified 13 eligible studies, none of which with a priori controls. So data synthesis focused on the 226 patients who received thiotepa. Based on pooled estimates, 75.9% of thiotepa-treated patients achieved a complete remission (95% confidence interval [CI] = 67.5–82.8), and 61.7% had a progression-free survival for up to 125 months post-treatment (95% CI = 49.4–72.7). However, 25.5% relapsed, 24.6% experienced infection, and 13.2% experienced neurotoxicity. Discussion. Thiotepa-based conditioning followed by HSCT may be effective in most CNS lymphoma patients, with a manageable toxicity profile. But adequately powered randomized trials are needed to better evaluate and isolate the effects of thiotepa.

Keywords::

• Clinical results
• infectious complications
• stem cell mobilization
• transplant toxicity
• lymphoma and Hodgkin disease

Acknowledgements

We would like to warmly thank Ms. Chieny D. Buenaventura and Mr. Nicholas A. Fergusson for their valuable contribution to data selection, retrieval and extraction, as well as Dr. Juthaporn Cowan for helping us abstract information from a Japanese article.

This project was funded by a grant from Adienne^®, the company licensed for the marketing of thiotepa (TEPADINA^®) in Europe and the United States of America.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at http://www.informahealthcare.com/lal.