The role of upfront autologous stem cell transplantation in high-risk younger patients with primary central nervous system lymphoma

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• 作者：Hyunsoo Cho ; Jong Hee Chang ; Yu Ri Kim ; Soo-Jeong Kim ; Haerim Chung ; Hyunsung Park ; Jung Yeon Lee ; Ji Eun Jang ; Yundeok Kim ; Se Hoon Kim ; Woo Ick Yang ; Chang-Ok Suh ; June-Won Cheong ; Yoo Hong Min and Jin Seok Kim
• 刊名：British Journal of Haematology
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：174
• 期：3
• 页码：444-453
• 全文大小：230K
• ISSN：1365-2141

文摘

Upfront autologous stem cell transplantation (ASCT) has shown favourable outcome in patients with primary central nervous system lymphoma (PCNSL), but the role of risk-adapted upfront ASCT consolidation has not been evaluated in PCNSL. As PCNSL patients with the International Extranodal Lymphoma Study Group (IELSG) prognostic score ≥2 or those who did not achieve complete response after two courses of induction chemotherapy (non-CR1) have shown inferior outcomes, we retrospectively analysed the role of upfront ASCT in 66 high-risk (IELSG ≥2 and/or non-CR1) younger (age <65 years) immunocompetent PCNSL patients who achieved at least partial response after initial high-dose methotrexate-based chemotherapy. Nineteen patients who received upfront ASCT exhibited significantly better overall survival (OS, P = 0·021) and progression-free survival (PFS, P = 0·005) compared to 47 patients who did not. In univariate and multivariate analyses, upfront ASCT was associated with better OS (P = 0·037 and P = 0·025, respectively) and PFS (P = 0·009 and P = 0·007, respectively). In a propensity score-matched cohort (n = 36), patients who received upfront ASCT also showed better outcome (P = 0·037 for OS, P = 0·001 for PFS). Our results suggest that upfront ASCT consolidation might be especially beneficial for high-risk PCNSL patients.