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

Antonio Omuro, Denise D. Correa, Lisa M. DeAngelis, Craig Moskowitz, Matthew J. Matasar, Thomas J. Kaley, Igor T. Gavrilovic, Craig Nolan, Elena Pentsova, Christian C. Grommes, Katherine S. Panageas, Raymond E. Baser, Geraldine Faivre, Lauren E. Abrey, Craig S. Sauter

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122 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1403-1410
Number of pages8
JournalBlood
Volume125
Issue number9
DOIs
StatePublished - Feb 26 2015
Externally publishedYes

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ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Omuro, A., Correa, D. D., DeAngelis, L. M., Moskowitz, C., 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. (2015). R-MPV followed by high-dose chemotherapy with TBC and autologous stem-cell transplant for newly diagnosed primary CNS lymphoma. Blood, 125(9), 1403-1410. https://doi.org/10.1182/blood-2014-10-604561