Contributions
Abstract: PB1713
Type: Publication Only
Background
CNSL represent 4 % of primary central nervous system (PCNSL) and secondary CNS lymphoma (SCNSL) occur in 7% of systemic lymphoma. Overall survival (OS) and progression free survival (PFS) have dramatically increased in PSNCL since the introduction of Methotrexate high doses and ASCT usually conditioning with TBC (Thiotepa, Busulfan and Cyclophosphamide). The studies usually tend to recommend TBC/ASCT in front line for patients under 65 years with CNSL with very few prospective data about this strategy.
Aims
Methods
Results
24 patients, without any major co-morbidity, were included. Median age at ASCT was 58 years (23-66). 22 of 24 were DLBCL and 2 follicular lymphoma and there were 15 PCNSL and 9 SCNSL. All but one, received 1 or 2 lines of chemotherapy (with high doses Methotrexate in first or second line) before ASCT. 15 were in complete response (CR) and 9 in partial response (PR) before TBC/ASCT. Median duration of hospitalisation was 33 days (15-78 d) and of aplasia was 14 days (7-37 d). Median follow-up was 10 months (0-73). At the end of follow up 5 patients have died. Among the 3 patients older than 60 years in PR before ACSCT, no one survived. At 1 year, OS and PFS were respectively 78% and 73%.
WHO criteria | Grade I-II | Grade III | Grade IV | All |
Infections | 13 | 2 | 9 | 24 |
Neurologic | 4 | 1 | 4 | 9 |
Mucositis | 5 | 7 | 3 | 15 |
Cutaneous | 5 | 2 | 0 | 7 |
Colitis | 18 of 24 (75%) | |||
Renal dysfunction | 2 of 24 | |||
Haemorrhagic cystitis | 2 of 24 | |||
Conclusion
To our knowledge, here is one of the biggest retrospective cohort concerning TBC/ASCT in CNSL. If TBC seems to give interesting response rates (72% CR), we noted an unacceptable toxicity compared to other used conditionnings (for example TRM with Thiotepa Carmustine is 1%). Our high toxicity rates (66%≥grade 3), especially in elderly patients, with neurological adverse events and infections (with unusual microbiological agents) lead us to disadvise the use of TBC before ASCT.
Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Autologous peripheral blood stem cell tansplantati, toxicity, lymphoma, Conditioning
Abstract: PB1713
Type: Publication Only
Background
CNSL represent 4 % of primary central nervous system (PCNSL) and secondary CNS lymphoma (SCNSL) occur in 7% of systemic lymphoma. Overall survival (OS) and progression free survival (PFS) have dramatically increased in PSNCL since the introduction of Methotrexate high doses and ASCT usually conditioning with TBC (Thiotepa, Busulfan and Cyclophosphamide). The studies usually tend to recommend TBC/ASCT in front line for patients under 65 years with CNSL with very few prospective data about this strategy.
Aims
Methods
Results
24 patients, without any major co-morbidity, were included. Median age at ASCT was 58 years (23-66). 22 of 24 were DLBCL and 2 follicular lymphoma and there were 15 PCNSL and 9 SCNSL. All but one, received 1 or 2 lines of chemotherapy (with high doses Methotrexate in first or second line) before ASCT. 15 were in complete response (CR) and 9 in partial response (PR) before TBC/ASCT. Median duration of hospitalisation was 33 days (15-78 d) and of aplasia was 14 days (7-37 d). Median follow-up was 10 months (0-73). At the end of follow up 5 patients have died. Among the 3 patients older than 60 years in PR before ACSCT, no one survived. At 1 year, OS and PFS were respectively 78% and 73%.
WHO criteria | Grade I-II | Grade III | Grade IV | All |
Infections | 13 | 2 | 9 | 24 |
Neurologic | 4 | 1 | 4 | 9 |
Mucositis | 5 | 7 | 3 | 15 |
Cutaneous | 5 | 2 | 0 | 7 |
Colitis | 18 of 24 (75%) | |||
Renal dysfunction | 2 of 24 | |||
Haemorrhagic cystitis | 2 of 24 | |||
Conclusion
To our knowledge, here is one of the biggest retrospective cohort concerning TBC/ASCT in CNSL. If TBC seems to give interesting response rates (72% CR), we noted an unacceptable toxicity compared to other used conditionnings (for example TRM with Thiotepa Carmustine is 1%). Our high toxicity rates (66%≥grade 3), especially in elderly patients, with neurological adverse events and infections (with unusual microbiological agents) lead us to disadvise the use of TBC before ASCT.
Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Autologous peripheral blood stem cell tansplantati, toxicity, lymphoma, Conditioning