Université de Lorraine, Department of Hematology, CHRU de Nancy, Hôpital de Brabois, Nancy, France.
Department of Neurology, APHP, Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Bone Marrow Transplant. 2022 Jun;57(6):966-974. doi: 10.1038/s41409-022-01648-z. Epub 2022 Apr 14.
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.
我们分析了 2011 年至 2019 年 11 月期间在法国中枢神经系统淋巴瘤前瞻性数据库中连续登记并接受强化化疗(IC)联合自体干细胞移植(IC-ASCT)治疗的原发性中枢神经系统淋巴瘤(PCNSL)患者的治疗结果(共招募 271 例患者,266 例进行了分析)。此外,我们还分析了 3 个中心的 85 例患者的源文件中以噻替哌为基础的 IC-ASCT 的治疗相关并发症。患者接受 IC-ASCT 的治疗时机为一线治疗(n=147)或复发后(n=119)。IC-ASCT 时的中位年龄为 57 岁(范围:22-74 岁)。IC 方案包括噻替哌-卡氮芥(n=64)、噻替哌-白消安(n=24)、BCNU-依托泊苷-阿糖胞苷-美法仑(BEAM,n=36)和噻替哌-白消安-环磷酰胺(n=142)。多因素分析显示,BEAM 和复发后 ASCT 是复发风险的不良预后因素。复发后 ASCT 的治疗相关死亡率较高,噻替哌-白消安-环磷酰胺似乎更高。噻替哌-卡氮芥的复发率高于噻替哌-白消安-环磷酰胺和噻替哌-白消安。这项研究证实了 IC-ASCT 在一线治疗和首次复发 PCNSL 中的作用(5 年总生存率分别为 80%和 50%)。通过更早地考虑疾病进程中的 ASCT 和调整 IC 剂量,可以改善噻替哌-白消安/噻替哌-白消安-环磷酰胺-ASCT 的获益/风险比。
Transplant Cell Ther. 2023-8