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. 2022 Apr 12;6(7):2267-2274.
doi: 10.1182/bloodadvances.2021005602.

Autologous stem cell transplantation for large B-cell lymphoma with secondary central nervous system involvement

Serkan Akin  1   2 , Chitra Hosing  1 , Issa Khouri  1 , Sairah Ahmed  1   3 , Amin Alousi  1 , Nathan Fowler  3 , Jacinth Joseph  1 , Jonathan Truxillo  1 , Jeremy L Ramdial  1 , Farzaneh Maadani  1 , Gabriela Rondon  1 , May Daher  1 , Jin S Im  1 , Raphael Steiner  3 , Jason Westin  3 , Swaminathan P Iyer  3 , Bouthaina Dabaja  4 , Paolo Anderlini  1 , Uday R Popat  1 , Muzaffar H Qazilbash  1 , Christopher R Flowers  3 , Elizabeth Shpall  1 , Richard E Champlin  1 , Yago Nieto  1 , Samer A Srour  1
Affiliations

Autologous stem cell transplantation for large B-cell lymphoma with secondary central nervous system involvement

Serkan Akin et al. Blood Adv. .

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.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Survival, relapse and mortality rates for all study patients. (A) PFS. (B) OS. (C) CIR. (D) NRM.
Figure 2.
Figure 2.
Comparison of survival outcomes by disease status at transplant and prior lines of therapy. (A-B) PFS and OS by disease status. (C-D) PFS and OS by prior lines of therapy. CR/CRu, complete response/complete response uncertain.
See this image and copyright information in PMC

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