Intensive chemotherapy followed by autologous stem cell transplantation in primary central nervous system lymphomas (PCNSLs). Therapeutic outcomes in real life-experience of the French network

authors

• Schenone Laurence
• Houillier Caroline
• Tanguy Marie Laure
• Choquet Sylvain
• Agbetiafa Kossi
• Ghesquières Hervé
• Damaj Gandhi
• Schmitt Anna
• Bouabdallah Krimo
• Ahle Guido
• Gressin Remy
• Cornillon Jérôme
• Houot Roch
• Marolleau Jean-Pierre
• Fornecker Luc-Matthieu
• Chinot Olivier
• Peyrade Frédéric
• Bouabdallah Reda
• Moluçon-Chabrot Cécile
• Gyan Emmanuel
• Chauchet Adrien
• Casasnovas Olivier
• Oberic Lucie
• Delwail Vincent
• Abraham Julie
• Roland Virginie
• Waultier-Rascalou Agathe
• Willems Lise
• Morschhauser Franck
• Fabbro Michel
• Ursu Renata
• Thieblemont Catherine
• Jardin Fabrice
• Tempescul Adrian
• Malaise Denis
• Touitou Valérie
• Nichelli Lucia
• Le Garff-Tavernier Magali
• Plessier Aurélie
• Bourget Philippe
• Bonmati Caroline
• Wantz-Mézières Sophie
• Giordan Quentin
• Dorvaux Véronique
• Charron Cyril
• Jabeur Waliyde
• Hoang-Xuan Khê
• Taillandier Luc
• Soussain Carole

document type

abstract

We analysed the therapeutic outcomes of all consecutive patients with primary central nervous system lymphoma (PCNSL) registered in the prospective French database for PCNSL and treated with intensive chemotherapy (IC) followed by autologous stem cell transplantation (IC-ASCT) between 2011 and November 2019 (271 patients recruited, 266 analysed). In addition, treatment-related complications of thiotepa-based IC-ASCT were analysed from the source files of 85 patients from 3 centers. Patients had received IC-ASCT either in first-line treatment (n\,=\,147) or at relapse (n\,=\,119). The median age at IC-ASCT was 57 years (range: 22-74). IC consisted of thiotepa-BCNU (n\,=\,64), thiotepa-busulfan (n\,=\,24), BCNU-etoposide-cytarabine-melphalan (BEAM, n\,=\,36) and thiotepa-busulfan-cyclophosphamide (n\,=\,142). In multivariate analysis, BEAM and ASCT beyond the first relapse were adverse prognostic factors for relapse risk. The risk of treatment-related mortality was higher for ASCT performed beyond the first relapse and seemed higher for thiotepa-busulfan-cyclophosphamide. Thiotepa-BCNU tends to result in a higher relapse rate than thiotepa-busulfan-cyclophosphamide and thiotepa-busulfan. This study confirms the role of IC-ASCT in first-line treatment and at first-relapse PCNSL (5-year overall survival rates of 80 and 50%, respectively). The benefit/risk ratio of thiotepa-busulfan/thiotepa-busulfan-cyclophosphamide-ASCT could be improved by considering ASCT earlier in the course of the disease and dose adjustment of the IC.

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