High-dose chemo plus stem cell transplant effective for CNS lymphoma
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A literature review presented at the ASCO2020 Virtual Scientific Program showed the efficacy of high-dose chemotherapy in conjunction with allogeneic hematopoietic stem cell transplant in treating central nervous system lymphoma.
“Primary CNS lymphoma has historically carried a poor prognosis, and there is no universally accepted regimen. Modern chemotherapeutic regimens have improved response rates. However, relapse remains very high, and on the other hand, a whole brain radiation therapy has improved short-term outcomes, but it’s associated with severe neurotoxicity,” Shaha Nabeel, MD, medical resident at Northwell Health, said in her recorded presentation.
Nabeel presented a systemic literature review of the treatment outcomes in primary CNS lymphoma after sequential treatment with different high-dose chemotherapy (HDCT) regimens followed by allogeneic hematopoietic stem cell transplant (ASCT). The review comprised eight studies and Nabeel pointed out that the average age in these studies was lower than the average age of primary CNS lymphoma, so further studies are warranted.
“All of these small structured trials represented appreciable results in terms of progression-free survival and overall survival with HDCT followed by ASCT as first-line therapy for primary CNS lymphoma,” Nabeel said. “However, a single optimal treatment regimen could not be determined. Newly diagnosed primary CNS lymphoma patients showed superior outcomes in terms of progression-free survival and overall survival. And inferior outcomes in relapsed refractory patients could be because of the mortality associated with neurotoxicity from the whole brain radiation therapy which they received in prior treatments.”
Nabeel indicated that combinations of high-dose rituximab, busulfan and cyclophosphamide significantly improved survival outcomes in relapse/refractory patients. The review showed that patients treated with BEAM regimen – a combination of carmustine, etoposide, cytarabine and melphalan – combined with ASCT relapsed 50% of the time. But Nabeel linked the use of lipophilic drugs, particularly thiotepa and bulsulfan, to superior outcomes. The researchers reported age as the biggest contributing factor to long-term neurological and other acute side effects.
“Primary CNS lymphoma treated with high-dose chemotherapy followed by allogeneic stem cell transplant has shown promising outcomes and has indeed set a benchmark for future studies,” Nabeel concluded.
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Nabeel S, et al. Abstract 311551. Presented at: ASCO20 Virtual Scientific Program; May 29-31, 2020.
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