This is often short-lived, mostly because of the unavailability of feasible and effective consolidative strategies.

High-dose thiotepa-based chemotherapy with autologous stem cell support in elderly patients with primary central nervous system lymphoma: a European retrospective study.

Treatment Response and Survival after HDT/ASCT. 23 10 (pg. Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. Phase 1 investigation of lenalidomide/rituximab plus outcomes of lenalidomide maintenance in relapsed CNS lymphoma. More than one-half of patients with primary central nervous system lymphoma receiving high-dose chemotherapy (HDT) without thiotepa experienced relapse. Autologous stem cell transplant can provide significant remission that is both long and deep, extending survival. Numerous retrospective [. OS was defined as the time from transplantation to death or latest follow-up. Contribution of BEAM/ASCT to response rate was modest, with a 44% CRR after MVBP induction and 52% after BEAM, with a 4-year EFS and OS for the whole series of 46% and 64%, respectively.21  Notably, all enrolled patients received intrathecal chemotherapy and WBRT, which prevents drawing definitive conclusions on the effect of BEAM on survival. High-dose chemotherapy and autologous stem-cell transplantation without consolidating radiotherapy as first-line treatment for primary lymphoma of the central nervous system. OS (A) and PFS (B) in HDT/ASCT upfront setting (black lines) or as salvage therapy (gray lines).

All the stem cells are collected from the patient before the first-high dose chemotherapy treatment. Guidelines from the European Association of Neuro-Oncology consider up-front HDC/ASCT as an experimental treatment in PCNSL,4  whereas National Comprehensive Cancer Network guidelines for routine practice refers to HDC/ASCT as an alternative to WBRT in patients who achieve CR after HD-MTX–containing induction.14. 2670-2675) Google Scholar. The purpose of this retrospective study based on the Japan Society for Hematopoietic Cell Transplantation (JSHCT) registry database was to provide the outcomes of HDT/ASCT in patients with PCNSL in Japan and to investigate the role of each chemotherapeutic agent in HDT regimens.

Similarly, a growing inclination to avoid radiotherapy in patients achieving complete remission (CR) after induction chemotherapy has been applied also to PCNSL.11  This choice is strongly motivated by the previously mentioned association between WBRT and risk of severe neurotoxicity.5  However, WBRT withdrawal should be considered with caution as the situation is completely different in PCNSL, where the quality of response after chemotherapy is suboptimal compared with DLBCL patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP). Introduction of Transplant Registry Unified Management Program 2 (TRUMP2): scripts for TRUMP data analyses, part I (variables other than HLA-related data). The only phase 2 trial addressing BEAM-conditioned ASCT in a radiotherapy-free program was a monoinstitutional experience from the Memorial Sloan Kettering Cancer Center.20  In this trial, a sequential combination of high doses of MTX and ARAC followed by BEAM/ASCT resulted in 57% ORR after induction, with half of enrolled patients receiving ASCT. Crossref.

Two of these patients were treated with ACNU-thiotepa, 1 was treated with BuTT, 1 was treated with MEAM, and 1 was treated with MCEC.

Treatment of relapsed central nervous system lymphoma with high-dose methotrexate. As an overall strategy, these randomized trials will establish the best consolidative strategy as part of first-line treatment in PCNSL patients but, at the same time, will suggest which of these strategies could be kept to consolidate responses to chemotherapy in patients with relapsed/refractory disease. However, several questions on efficacy and feasibility of HDC/ASCT, as well as the best candidates for this strategy, the optimal conditioning regimen, the best time for response assessment, and acute and late effects, remain unanswered. Assessment by formal neuropsychological tests showed significant improvement in some cognitive functions, with no evidence of neurologic decline. However, increased risk of severe neurotoxicity, especially in elderly patients, has been reported with chemo-radiation therapy.5  Recent international efforts have focused on establishing valid alternatives to consolidative WBRT, mostly consisting of high-dose chemotherapy supported by autologous stem cell transplantation (HDC/ASCT)6  or nonmyeloablative chemotherapy.7  HDC/ASCT is supported by several single-arm phase 2 trials and is the only one that is compared with WBRT in ongoing randomized trials. Cognitive functions in survivors of primary central nervous system lymphoma. In autologous stem cell transplantation, stem cells are collected (or “harvested”) from either the bone marrow, bloodstream (called a peripheral blood stem cell harvest), or sometimes a combination of both. Prognosis after high-dose chemotherapy followed by autologous stem-cell transplantation as first-line treatment in primary CNS lymphoma--a long-term follow-up study. Temozolomide as salvage treatment in primary brain lymphomas. MEAM indicates MCNU + etoposide + cytarabine + melphalan; BuMel, busulfan + melphalan; LEED, melphalan + etoposide + cyclophosphamide + dexamethasone; MCEC, MCNU + calboplatin + etoposide + cyclophosphamide; TBC, thiotepa + busulfan + cyclophosphamide; BuCy, busulfan + cyclophosphamide; BuTT, busulfan + thiotepa; BuCyE, busulfan + cyclophosphamide + etoposide. An autologous stem cell transplant (ASCT) is one that uses healthy hemopoietic stem cells (those that form the blood cells) from a person’s own body—instead of taking stem cells from a donor—to replace diseased bone marrow or bone marrow damaged by cancer treatment. High-dose thiotepa, busulfan, cyclophosphamide and ASCT without whole-brain radiotherapy for poor prognosis primary CNS lymphoma. Flows and flaws in primary central nervous system lymphoma. OS (A) and PFS (B) from the time of HDT/ASCT. A comprehensive assessment of toxicities in patients with central nervous system lymphoma undergoing autologous stem cell transplantation using thiotepa, busulfan, and cyclophosphamide conditioning. At a median follow-up of 45 months, the PFS and OS were 81%, but these encouraging results should be considered cautiously, with only 19% of the study group having high risk scores.26  Overall, these studies have suggested TBC regimen is active in patients with newly diagnosed PCNSL responsive to HD-MTX–based induction, but toxicity remains a major concern.27,28,43  In fact, a median length of hospital stay of 24 to 28 days, median time to neutrophil and platelet recovery of respectively 9 and 13 days have been reported.26,27,43  Importantly, septic complications, mostly bacterial infections, occur in one-third of treated patients,26,27,43  with grade ≥3 febrile neutropenia in 42% of patients, grade ≥3 infections in 23%, nonrelapse mortality of up to 24%, and a TRM of up to 19%. 2019, Received: Whole-brain radiotherapy or autologous stem-cell transplantation as consolidation strategies after high-dose methotrexate-based chemoimmunotherapy in patients with primary CNS lymphoma: results of the second randomisation of the International Extranodal Lymphoma Study Group-32 phase 2 trial. With a wider use of rituximab, and 18fluorodeoxyglucose positron emission tomography (PET) in particular, the role of consolidative radiotherapy in extra-CNS DLBCL was constrained, even if randomized trials focused on this issue in the rituximab era do not exist.10  This is mostly because of better disease control with immunochemotherapy and an improved definition of response degree in patients with residual masses at computed tomography scan. Correspondence: Andrés J. M. Ferreri, Unit of Lymphoid Malignancies, Division of Onco-Hematological Medicine, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; e-mail: ferreri.andres@hsr.it. Several strategies have been proposed for the consolidation phase, with whole-brain irradiation (WBRT) the most common. Two of these 7 died within 100 days of ASCT, 1 from infection with an unknown pathogen (on day 81) at age 49 years and 1 from sepsis (on day 98) age 61 years. Both regimens were assessed in small retrospective series of Asian patients.23,24  BUCYE regimen (busulfan, 3.2 mg/kg per day, days −7 to −5; cyclophosphamide, 50 mg/kg per day, days −3 and −2; etoposide, 200 mg/m2, twice a day, days −5 and −4) was tested after induction with sequential high-dose MTX and ARAC in 11 Korean patients with PCNSL.23  This regimen was associated with grade 3 diarrhea in 2 patients and febrile neutropenia in 10; no patients died of toxicity. Distinctive infectious complications in patients with central nervous system lymphoma undergoing thiotepa, busulfan, and cyclophosphamide-conditioned autologous stem cell transplantation. Brain Tumor Registry of Japan (2001-2004). With anecdotal exceptions, only patients with PCNSL responsive to induction phase are referred for HDC/ASCT.

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