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. 2023 Jan 29;11(1):14.
doi: 10.3390/medsci11010014.

Thiotepa, Busulfan, Cyclophosphamide: Effective but Toxic Conditioning Regimen Prior to Autologous Hematopoietic Stem Cell Transplantation in Central Nervous System Lymphoma

Lebon Delphine  1 , Debureaux Pierre-Edouard  2 , Royer Bruno  2 , Gruson Bérengère  1 , Joris Magalie  1 , Votte Patrick  1 , Marolleau Jean-Pierre  1 , Morel Pierre  1
Affiliations

Thiotepa, Busulfan, Cyclophosphamide: Effective but Toxic Conditioning Regimen Prior to Autologous Hematopoietic Stem Cell Transplantation in Central Nervous System Lymphoma

Lebon Delphine et al. Med Sci (Basel). .

Abstract

In primary central nervous system lymphoma, two-year progression-free survival rates of up to 63 percent have been reported for first-line autologous stem cell transplantation after conditioning with the thiotepa busulfan cyclophosphamide regimen. However, 11 percent of the patients died due to toxicity. Besides conventional survival, progression-free survival and treatment related mortality analyses, a competing-risk analysis was applied to our cohort of twenty-four consecutive patients with primary or secondary central nervous system lymphoma who underwent autologous stem cell transplantation after thiotepa busulfan cyclophosphamide conditioning. The two-year overall survival and progression-free survival rates were 78 percent and 65 percent, respectively. The treatment-related mortality rate was 21 percent. The competing risks analysis demonstrate that age 60 or over and the infusion of less than 4.6 × 106/kg CD34+ stem cells were significant adverse prognostic factors for overall survival. Autologous stem cell transplantation with thiotepa busulfan cyclophosphamide conditioning was associated with sustained remission and survival. Nevertheless, the intensive thiotepa busulfan cyclophosphamide conditioning regimen was highly toxic, especially in older patients. Thus, our results suggest that future studies should aim at identifying the subgroup of patients who will really benefit of the procedure and/or to reduce the toxicity of future conditioning regimen.

Keywords: adverse events; autologous hematopoietic stem cell transplantation; central nervous system lymphoma; conditioning; infections.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The OS rate (A) and the PFS rate (B).
Figure 2
Figure 2
The PFS curves, by age.
Figure 3
Figure 3
Cumulative incidence of death without progression (i.e., TRM) (A) and disease progression (B), by age.
See this image and copyright information in PMC

References

    1. DeAngelis L.M., Yahalom J., Thaler H.T., Kher U. Combined modality therapy for primary CNS lymphoma. J. Clin. Oncol. 1992;10:635–643. doi: 10.1200/JCO.1992.10.4.635. - DOI - PubMed
    1. Haas R.L.M., Poortmans P., de Jong D., Aleman B.M.P., Dewit L.G.H., Verheij M., Hart A.A.M., van Oers M.H.J., van der Hulst M., Baars J.W., et al. High Response Rates and Lasting Remissions After Low-Dose Involved Field Radiotherapy in Indolent Lymphomas. J. Clin. Oncol. 2003;21:2474–2480. doi: 10.1200/JCO.2003.09.542. - DOI - PubMed
    1. Gavrilovic I.T., Hormigo A., Yahalom J., DeAngelis L.M., Abrey L.E. Long-Term Follow-Up of High-Dose Methotrexate-Based Therapy with and Without Whole Brain Irradiation for Newly Diagnosed Primary CNS Lymphoma. J. Clin. Oncol. 2006;24:4570–4574. doi: 10.1200/JCO.2006.06.6910. - DOI - PubMed
    1. O’Brien P.C., Roos D.E., Pratt G., Liew K.-H., Barton M.B., Poulsen M.G., Olver I.N., Trotter G.E. Combined-modality therapy for primary central nervous system lymphoma: Long-term data from a Phase II multicenter study (Trans-Tasman Radiation Oncology Group) Int. J. Radiat. Oncol. *Biol. *Phys. 2006;64:408–413. doi: 10.1016/j.ijrobp.2005.07.958. - DOI - PubMed
    1. O’Brien P., Roos D., Pratt G., Liew K., Barton M., Poulsen M., Olver I., Trotter G. Phase II Multicenter Study of Brief Single-Agent Methotrexate Followed by Irradiation in Primary CNS Lymphoma. J. Clin. Oncol. 2000;18:519. doi: 10.1200/JCO.2000.18.3.519. - DOI - PubMed