High-dose chemotherapy with autologous haematopoietic stem cell transplantation in patients with isolated vitreoretinal lymphoma: a LOC network study

authors

• Mainguy Adam
• Soussain Carole
• Touitou Valérie
• Bennedjai Amin
• Kodjikian Laurent
• Ghesquières Hervé
• Damaj Gandhi
• Gressin Rémy
• Ducloyer Jean-Baptiste
• Chinot Olivier
• Vautier Anaïs
• Moluçon-Chabrot Cécile
• Ahle Guido
• Taillandier Luc
• Marolleau Jean Pierre
• Chauchet Adrien
• Jardin Fabrice
• Cassoux Nathalie
• Malaise Denis
• Toutée Adélaïde
• Touhami Sara
• Le Garff-Tavernier Magali
• Hoang-Xuan Khê
• Choquet Sylvain
• Houillier Caroline

abstract

Despite its indolent evolution, vitreoretinal lymphoma (VRL) has a poor prognosis due to a major risk of relapse in the central nervous system (CNS) and may necessitate aggressive therapy. However, the use of high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) is poorly documented. We retrospectively analysed from the French LOC network database the adult immunocompetent patients treated with HCT-ASCT for isolated VRL. Thirty-eight patients underwent consolidation with HCT-ASCT for isolated VRL between 2008 and 2019 after induction chemotherapy. Twenty patients had primary VRL, and 18 had an isolated VRL relapse of a primary CNS lymphoma. Three patients underwent HCT-ASCT in first-line treatment, 24 in second-line treatment, and 11 in subsequent lines. At HCT-ASCT, the median age was 61 years, and the median KPS was 90. Thirty-two patients (84%) received high-dose thiotepa-based HCT. One patient (3%) died from HCT-ASCT toxicity. Nineteen (50%) patients relapsed after HCT-ASCT, including 17 cases occurring in the brain. The median progression-free survival, brain-free survival and overall survival from HCT-ASCT were 96, 113 and 92 months, respectively. HCT-ASCT represents an effective therapeutic strategy for select VRL patients, with a tolerable safety profile. However, the risk of subsequent brain relapse remains significant.

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