Treatment > Methotrexate · Stem Cells

Meeting Abstract

Phase II trial of high-dose chemotherapy with autologous stem cell transplantation in first-line therapy of primary central nervous system (CNS) lymphoma

P. Colombat, T. Lamy, A. Lemevel, V. Delwail, M. Gardembas, A. Brion, C. Berthou, J.-O. Bay, R. Delepine, C. Linassier

for the Goelams Study Group; CHU Bretonneau, Tours, France; CHU Pontchaillou, Rennes, France; Centre Rene Gauducheau, Nantes, France; CHU la Mileterie, Poitiers, France; CHU, Angers, France; CHU, Besancon, France; CHU, Brest, France; Centre Jean Perrin, Clermont-Ferrand, France

Introduction. The prognosis of primary CNS lymphoma remains poor with conventional chemotherapy and radiotherapy.
High-dose chemotherapy (HDT) with autologous blood stem cell transplantation (ASCT) has given encouraging results as salvage treatment.
We conducted a phase II study between July 99 and November 2001 to evaluate the efficacy of HDT in the first-line treatment of primary CNS.

Patients and Methods. Eligible criteria were histologically proven lymphoma, age £ 60 years, no immunodeficiency, adequate liver, renal, lung and hematopoietic function.
Patients (pts) received 2 courses of MVBP (Methotrexate 3 g/m²/d d1,5), VP16 100 mg/m² on d2, BCNU 100 mg/m² on d3, methylprednisolone 60 mg/m²/day, d1-5) and intrathecal prophylaxis; patients in complete or partial remission, had peripheral blood stem cells collection after ifosfamide (1,5 g/m² on d1-3) and cytarabine (2 g/m²/day on d1-2); HDT with BEAM (BCNU 300 mg/m² d1, VP16 400 mg/m²/d d2-5, cytarabine 200 mg/m²/d d2-5 and melphalan 140 mg/m² d6) was supported by ASCT; after transplantation, patients had whole brain irradiation at a dose of 30 Gy, 1.8 Gy/fr.

Results. 25 patients, 9 men and 16 women, were included.
Median age was 51 years (21-60).
All patients had diffuse large cell lymphoma.
ECOG performance status was 0 in 3 pts, 1 in 10 pts, 2 in 4 pts, 3 in 6 pts and 4 in 2 pts.
Twelve patients had a unique site and 13 had multifocal presentation.
Serum LDH level was increased in 6 pts.
HDT with BEAM was performed in 16 pts (4 progressions, 3 toxicities and 2 refusals).
One toxic death occured among the 16 pts treated with BEAM.
With a median follow-up time of 24.6 months (13-43), the probability of overall survival at 36 months was 55% for the whole population, 90% for patients who received BEAM intensive chemotherapy and 0% for pts who were not intensified.

Conclusion. High-dose chemotherapy with autologous blood stem cell transplantation is feasible and resulted in a high rate of disease control.
A longer follow is necessary but a randomized comparison with conventional chemotherapy including high-dose methotrexate is necessary.

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