A Comprehensive Assessment of Toxicities in Patients with Central Nervous System Lymphoma Undergoing Autologous Stem Cell Transplantation Using Thiotepa, Busulfan, and Cyclophosphamide Conditioning

Michael Scordo, Valkal Bhatt, Meier Hsu, Antonio M. Omuro, Matthew J. Matasar, Lisa M. DeAngelis, Parastoo B. Dahi, Craig Moskowitz, Sergio A. Giralt, Craig S. Sauter

Research output: Contribution to journalArticle

9 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)38-43
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume23
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Keywords

  • Autologous stem cell transplantation
  • Central nervous system lymphoma
  • High-dose therapy
  • Regimen-related toxicity
  • Toxicity

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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