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 |
| DOI/URL: | |
| Notes: | Export Date: 2 April 2015 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work