R-MPV followed by high-dose chemotherapy with TBC and autologous stem-cell transplant for newly diagnosed primary CNS lymphoma Journal Article

Authors: Omuro, A.; Correa, D. D.; Deangelis, L. M.; Moskowitz, C. H.; Matasar, M. J.; Kaley, T. J.; Gavrilovic, I. T.; Nolan, C.; Pentsova, E.; Grommes, C. C.; Panageas, K. S.; Baser, R. E.; Faivre, G.; Abrey, L. E.; Sauter, C. S.
Article Title: R-MPV followed by high-dose chemotherapy with TBC and autologous stem-cell transplant for newly diagnosed primary CNS lymphoma
Abstract: High-dose methotrexate-based chemotherapy is the mainstay of treatment of primary central nervous system lymphoma (PCNSL), but relapses remain frequent. High-dose chemotherapy (HDC) with autologous stem-cell transplant (ASCT) may provide an alternative to address chemoresistance and overcomethe blood-brain barrier. In this single-center phase-2 study, newly diagnosed PCNSL patients received 5 to 7 cycles of chemotherapy with rituximab, methotrexate (3.5 g/m2), procarbazine, and vincristine (R-MPV). Those with a complete or partial response proceeded with consolidation HDC with thiotepa, cyclophosphamide, and busulfan, followed by ASCT and no radiotherapy. Primary end point was 1-year progression-free survival (PFS), N = 32. Median age was 57, and median Karnofsky performance status 80. Following R-MPV, objective response rate was 97%, and 26 (81%) patients proceeded with HDC-ASCT. Among all patients, median PFS and overall survival (OS) were not reached (median follow-up: 45 months). Two-year PFS was 79% (95% confidence interval [CI], 58-90), with no events observed beyond 2 years. Two-year OS was 81% (95% CI, 63-91). In transplanted patients, 2-year PFS and OS were 81%. There were 3 treatment-related deaths. Prospective neuropsychological evaluations suggested relatively stable cognitive functions posttransplant. In conclusion, this treatment was associated with excellent disease control and survival, an acceptable toxicity profile, and no evidence of neurotoxicity thus far. © 2015 by The American Society of Hematology.
Keywords: adult; treatment response; aged; human cell; overall survival; busulfan; constipation; fatigue; cancer combination chemotherapy; diarrhea; side effect; primary central nervous system lymphoma; methotrexate; rituximab; drug megadose; nuclear magnetic resonance imaging; follow up; antineoplastic agent; progression free survival; quality of life; infection; multiple cycle treatment; phase 2 clinical trial; mucosa inflammation; nausea; dehydration; peripheral neuropathy; weight reduction; cyclophosphamide; vincristine; autologous stem cell transplantation; procarbazine; thiotepa; alanine aminotransferase blood level; aspartate aminotransferase blood level; febrile neutropenia; rash; alanine aminotransferase; aspartate aminotransferase; karnofsky performance status; peripheral blood stem cell; heart failure; folinic acid; thrombosis; neuropsychological test; brain disease; cognition; colitis; embolism; induction chemotherapy; filgrastim; faintness; human; male; female; priority journal; article
Journal Title: Blood
Volume: 125
Issue: 9
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2015-02-26
Start Page: 1403
End Page: 1410
Language: English
DOI: 10.1182/blood-2014-10-604561
PROVIDER: scopus
PMCID: PMC4342354
PUBMED: 25568347
Notes: Export Date: 2 April 2015 -- Source: Scopus
Citation Impact
MSK Authors
  1. Raymond E Baser
    76 Baser
  2. Craig Moskowitz
    392 Moskowitz
  3. Denise D Correa
    70 Correa
  4. Antonio Marcilio Padula Omuro
    195 Omuro
  5. Thomas Kaley
    110 Kaley
  6. Craig Steven Sauter
    210 Sauter
  7. Christian Grommes
    71 Grommes
  8. Lauren E Abrey
    276 Abrey
  9. Matthew J Matasar
    155 Matasar
  10. Katherine S Panageas
    373 Panageas
  11. Craig Nolan
    50 Nolan
  12. Geraldine M Faivre
    7 Faivre