Autologous Stem Cell Transplantation for Large B-Cell Lymphoma With Secondary Central Nervous System Involvement

Authors

Serkan Akin
Chitra Hosing
Issa Khouri
Sairah Ahmed
Amin Alousi
Nathan Fowler
Jacinth Joseph
Jonathan Truxillo
Jeremy L Ramdial
Farzaneh Maadani
Gabriela Rondon
May Daher
Jin S Im
Raphael Steiner
Jason Westin
Swaminathan P Iyer
Bouthaina Dabaja
Paolo Anderlini
Uday R Popat
Muzaffar H Qazilbash
Christopher R Flowers
Elizabeth Shpall
Richard E Champlin
Yago Nieto
Samer A Srour

Publication Date

4-12-2022

Journal

Blood Advances

Abstract

Secondary central nervous system large B-cell lymphoma (SCNSL) is rare, with a generally poor prognosis. There is limited data about the role of autologous stem cell transplantation (ASCT) in these high-risk patients. We explored in this study treatment outcomes and prognostic factors for patients with SCNSL who underwent ASCT. We included all consecutive patients who underwent ASCT at our institution. Primary endpoints were progression-free survival (PFS) and overall survival (OS). One-hundred two patients were identified. Median age at transplant was 56 (range, 21-71) years. With a median follow-up of 56 (range, 1-256) months, the median PFS and OS were 40 and 88 months, respectively. The 4-year PFS and OS were 48% and 57%, respectively. In univariate analysis, complete remission (CR) at transplant, prior lines of therapy (≤2), normal lactate dehydrogenase, and parenchymal involvement were significantly associated with improved PFS. For OS, only CR at transplant and ≤2 prior lines of therapy were associated with improved survival. On multivariable analysis for PFS, CR at transplant (hazard ratio [HR], 0.278; 95% CI, 0.153-0.506; P ≤ .0001) and ≤2 prior lines of therapy (HR, 0.485; 95% CI, 0.274-0.859; P = .0131) were significantly associated with superior PFS. Similarly, CR at transplant (HR, 0.352; 95% CI, 0.186-0.663; P = .0013) and ≤2 prior lines of therapy (HR, 0.476; 95% CI, 0.257-0.882; P = .0183) were associated with improved survival. In the largest single-center study, our findings indicate that ASCT is associated with durable responses and prolonged survival in patients with SCNSL. Patients in CR at transplant and those who received ≤2 lines of therapy have particularly excellent outcomes.

Keywords

Antineoplastic Combined Chemotherapy Protocols, Central Nervous System, Hematopoietic Stem Cell Transplantation, Humans, Lymphoma, Large B-Cell, Diffuse, Transplantation, Autologous

DOI

10.1182/bloodadvances.2021005602

PMID

35008100

PMCID

PMC9006305

PubMedCentral® Posted Date

4-4-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes