Long-term outcomes in primary CNS lymphoma after R-MVP and high-dose chemotherapy with autologous hematopoietic stem cell transplant Journal Article

   

Authors:	Therkelsen, K. E.; Schaff, L. R.; Nandakumar, S.; Omuro, A. M. P.; Deangelis, L. M.; Grommes, C.
Article Title:	Long-term outcomes in primary CNS lymphoma after R-MVP and high-dose chemotherapy with autologous hematopoietic stem cell transplant
Abstract:	Background and ObjectivesPrimary CNS lymphoma (PCNSL), a rare CNS malignancy, is usually treated with high-dose methotrexate in the first-line setting, typically followed by consolidation therapy. Due to the broad range of currently available treatments for PCNSL, comparability in long-term follow-up studies is limited, and data are scattered across small studies.MethodsIn this study, we report the long-term survival of patients with newly diagnosed immunocompetent PCNSL, enrolled in a phase II trial from June 2005 to September 2011. Patients were treated using rituximab, methotrexate, vincristine, and procarbazine (R-MVP) chemotherapy followed by high-dose chemotherapy (HDC) and autologous stem cell transplant (ASCT) in those with partial or complete response to R-MVP. In a post hoc analysis, clinical and imaging features were evaluated in those still alive.Results26 of 32 patients underwent HDC-ASCT consolidation. Of them, 3 patients died of treatment-related toxicity and 2 due to disease progression within 1 year of ASCT. None of the remaining 21 patients had disease progression with a median follow-up of 12.1 years and were included in the analysis. Compared with the post-HDC-ASCT assessment, at the last follow-up, there was no significant difference in the median Karnofsky Performance Status (80 [range: 60-100] vs 90 [range: 70-100]), the median Neurologic Assessment in Neuro-Oncology score (1 [range: 0-4] vs 1 [range: 0-5]), and leukoencephalopathy score (1 [range: 0-3] vs 1 [range: 1-4]).DiscussionLong-term follow-up demonstrated that treatment was well tolerated in most patients enrolled in this study, with stable leukoencephalopathy on imaging and stable clinical performance status. Disease recurrence was not observed beyond 2 years after HDC-ASCT consolidation. © 2023 American Academy of Neurology.
Keywords:	multimodality cancer therapy; combined modality therapy; methotrexate; rituximab; antineoplastic agent; neoplasm recurrence, local; antineoplastic combined chemotherapy protocols; vincristine; hematopoietic stem cell transplantation; central nervous system tumor; central nervous system neoplasms; disease progression; tumor recurrence; lymphoma; transplantation, autologous; disease exacerbation; leukoencephalopathy; autotransplantation; leukoencephalopathies; procedures; humans; human
Journal Title:	Neurology
Volume:	101
Issue:	7
ISSN:	0028-3878
Publisher:	Lippincott Williams & Wilkins
Date Published:	2023-08-15
Start Page:	e710
End Page:	e716
Language:	English
DOI:	10.1212/wnl.0000000000207490
PUBMED:	37344228
PROVIDER:	scopus
PMCID:	PMC10437028
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85168221915&doi=10.1212%2fWNL.0000000000207490&partnerID=40&md5=7587b484e56dae492e46d73022bc2605
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Christian Grommes -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/208811