A comprehensive assessment of toxicities in patients with central nervous system lymphoma undergoing autologous stem cell transplantation using thiotepa, busulfan, and cyclophosphamide conditioning Journal Article


Authors: Scordo, M.; Bhatt, V.; Hsu, M.; Omuro, A. M.; Matasar, M. J.; DeAngelis, L. M.; Dahi, P. B.; Moskowitz, C. H.; Giralt, S. A.; Sauter, C. S.
Article Title: A comprehensive assessment of toxicities in patients with central nervous system lymphoma undergoing autologous stem cell transplantation using thiotepa, busulfan, and cyclophosphamide conditioning
Abstract: High-dose therapy and autologous stem cell transplantation (ASCT) with thiotepa, busulfan, and cyclophosphamide (TBC) conditioning has emerged as an effective postinduction treatment strategy for patients with primary central nervous system lymphoma (PCNSL) or secondary central nervous system lymphoma (SCNSL), but it is associated with considerable toxicity and transplantation-related mortality (TRM) in the modern era. Forty-three adult patients with chemosensitive PCNSL or SCNSL underwent TBC-conditioned ASCT between 2006 and 2015. Twenty-eight of these patients received pharmacokinetically (PK)-targeted busulfan dosing. The median number of clinically relevant individual grade ≥3 nonhematologic toxicities per patient was 5. We found no association between pretransplantation patient characteristics and the presence of more than 5 grade ≥3 nonhematologic toxicities. Patients with elevated first-dose busulfan area under the curve values did not experience more toxicity. Paradoxically, patients treated with more than 2 regimens before undergoing ASCT had lower first-dose busulfan AUC values. With a median follow-up among survivors of 20 months, 1-year progression-free survival (PFS) and overall survival (OS) from the time of ASCT were 83% and 87%, respectively. Although this study reaffirms the favorable PFS and OS associated with TBC-conditioned ASCT for PCNSL or SCNSL, this treatment strategy carries a large toxicity burden. © 2017 The American Society for Blood and Marrow Transplantation
Keywords: autologous stem cell transplantation; toxicity; high-dose therapy; central nervous system lymphoma; regimen-related toxicity
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 23
Issue: 1
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2017-01-01
Start Page: 38
End Page: 43
Language: English
DOI: 10.1016/j.bbmt.2016.09.024
PROVIDER: scopus
PUBMED: 27713090
PMCID: PMC5518313
DOI/URL:
Notes: Article -- Export Date: 3 January 2017 -- Source: Scopus
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MSK Authors
  1. Meier Hsu
    104 Hsu
  2. Craig Moskowitz
    375 Moskowitz
  3. Sergio Andres Giralt
    537 Giralt
  4. Antonio Marcilio Padula Omuro
    177 Omuro
  5. Craig Steven Sauter
    167 Sauter
  6. Matthew J Matasar
    122 Matasar
  7. Valkal Bhatt
    33 Bhatt
  8. Parastoo Bahrami Dahi
    85 Dahi
  9. Michael Scordo
    39 Scordo