Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Medical Oncology, The University of Hacettepe, Ankara, Turkey; and.
Blood Adv. 2022 Apr 12;6(7):2267-2274. doi: 10.1182/bloodadvances.2021005602.
Secondary central nervous system large B-cell lymphoma (SCNSL) is rare, with a generally poor prognosis. There is limited data about the role of autologous stem cell transplantation (ASCT) in these high-risk patients. We explored in this study treatment outcomes and prognostic factors for patients with SCNSL who underwent ASCT. We included all consecutive patients who underwent ASCT at our institution. Primary endpoints were progression-free survival (PFS) and overall survival (OS). One-hundred two patients were identified. Median age at transplant was 56 (range, 21-71) years. With a median follow-up of 56 (range, 1-256) months, the median PFS and OS were 40 and 88 months, respectively. The 4-year PFS and OS were 48% and 57%, respectively. In univariate analysis, complete remission (CR) at transplant, prior lines of therapy (≤2), normal lactate dehydrogenase, and parenchymal involvement were significantly associated with improved PFS. For OS, only CR at transplant and ≤2 prior lines of therapy were associated with improved survival. On multivariable analysis for PFS, CR at transplant (hazard ratio [HR], 0.278; 95% CI, 0.153-0.506; P ≤ .0001) and ≤2 prior lines of therapy (HR, 0.485; 95% CI, 0.274-0.859; P = .0131) were significantly associated with superior PFS. Similarly, CR at transplant (HR, 0.352; 95% CI, 0.186-0.663; P = .0013) and ≤2 prior lines of therapy (HR, 0.476; 95% CI, 0.257-0.882; P = .0183) were associated with improved survival. In the largest single-center study, our findings indicate that ASCT is associated with durable responses and prolonged survival in patients with SCNSL. Patients in CR at transplant and those who received ≤2 lines of therapy have particularly excellent outcomes.
继发性中枢神经系统大 B 细胞淋巴瘤（SCNSL）较为罕见，通常预后较差。目前关于自体造血干细胞移植（ASCT）在这些高危患者中的作用的数据有限。我们在本研究中探讨了接受 ASCT 的 SCNSL 患者的治疗结果和预后因素。我们纳入了在我们机构接受 ASCT 的所有连续患者。主要终点是无进展生存期（PFS）和总生存期（OS）。共确定了 102 例患者。移植时的中位年龄为 56 岁（范围，21-71 岁）。中位随访时间为 56 个月（范围，1-256 个月），中位 PFS 和 OS 分别为 40 个月和 88 个月。4 年 PFS 和 OS 分别为 48%和 57%。在单因素分析中，移植时完全缓解（CR）、治疗前的治疗线数（≤2 条）、正常乳酸脱氢酶和实质受累与改善 PFS 显著相关。对于 OS，仅移植时的 CR 和≤2 条治疗前的治疗线数与生存改善相关。在 PFS 的多变量分析中，移植时的 CR（风险比[HR]，0.278；95%置信区间，0.153-0.506；P≤0.0001）和≤2 条治疗前的治疗线数（HR，0.485；95%置信区间，0.274-0.859；P=0.0131）与更好的 PFS 显著相关。同样，移植时的 CR（HR，0.352；95%置信区间，0.186-0.663；P=0.0013）和≤2 条治疗前的治疗线数（HR，0.476；95%置信区间，0.257-0.882；P=0.0183）与生存改善相关。在最大的单中心研究中，我们的发现表明 ASCT 与 SCNSL 患者的持久反应和延长生存相关。移植时达到 CR 的患者和接受≤2 条治疗线数的患者具有特别优异的结果。
