Puckrin Robert, Stewart Colin, Owen Carolyn, Street Lesley E, Perry Sarah, Duggan Peter, Shafey Mona, Chua Neil, Stewart Douglas A
Tom Baker Cancer Centre and University of Calgary, Calgary, Canada.
Tom Baker Cancer Centre and University of Calgary, Calgary, Canada.
Clin Lymphoma Myeloma Leuk. 2025 Apr;25(4):265-270. doi: 10.1016/j.clml.2024.11.008. Epub 2024 Dec 13.
Thiotepa-based autologous stem cell transplantation (ASCT) improves survival in primary central nervous system lymphoma (PCNSL), but > 30% of patients are unable to undergo ASCT following commonly used intensive induction regimens.
This retrospective population-based study included consecutive patients ≥ 18 years old with PCNSL who were intended for ASCT in Alberta, Canada between 2011 and 2022. A reduced-intensity induction protocol was further abbreviated in 2018 to decrease toxicity and expediate ASCT by incorporating rituximab, procarbazine, and only 2 doses of high-dose methotrexate and 1 cycle of high-dose cytarabine before consolidation with thiotepa-busulfan conditioning. Progression-free survival (PFS) and overall survival (OS) were determined using the Kaplan-Meier method.
Among 71 patients with median age 58 years (range 26-72), ASCT was completed in 56 (79%), with the transplantation rate among patients > 60 years old increasing by 30% following the abbreviation of induction therapy. With median follow-up time 3.9 years, 4-year PFS and OS were 69% (95% CI 56%-79%) and 80% (95% CI 67%-88%) for all patients and 75% (95% CI 57%-86%) and 85% (95% CI 68%-93%) for ASCT recipients, respectively. There was 1 death due to treatment-related mortality during induction and none after ASCT, including among 17 transplanted patients > 60 years old.
An abbreviated induction regimen followed by thiotepa-busulfan-based ASCT achieves high transplantation rates with low risks of relapse and treatment-related mortality, thereby providing an effective treatment strategy for PCNSL.
基于噻替派的自体干细胞移植（ASCT）可提高原发性中枢神经系统淋巴瘤（PCNSL）患者的生存率，但采用常用的强化诱导方案后，超过30%的患者无法进行ASCT。
这项基于人群的回顾性研究纳入了2011年至2022年期间加拿大艾伯塔省连续的年龄≥18岁且计划进行ASCT的PCNSL患者。2018年，一种降低强度的诱导方案进一步简化，通过加入利妥昔单抗、丙卡巴肼，以及在使用噻替派-白消安预处理进行巩固之前仅使用2剂高剂量甲氨蝶呤和1周期高剂量阿糖胞苷，以降低毒性并加快ASCT进程。采用Kaplan-Meier方法确定无进展生存期（PFS）和总生存期（OS）。
在71例中位年龄为58岁（范围26 - 72岁）的患者中，56例（79%）完成了ASCT，诱导治疗简化后，60岁以上患者的移植率提高了30%。中位随访时间为3.9年，所有患者的4年PFS和OS分别为69%（95%CI 56% - 79%）和80%（95%CI 67% - 88%），ASCT接受者分别为75%（95%CI 57% - 86%）和85%（95%CI 68% - 93%）。诱导期间有1例因治疗相关死亡率死亡，ASCT后无死亡病例，包括17例60岁以上的移植患者。
采用简化诱导方案后进行基于噻替派-白消安的ASCT可实现高移植率，且复发风险和治疗相关死亡率低，从而为PCNSL提供了一种有效的治疗策略。
