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The role of upfront autologous stem cell transplantation in high-risk younger patients with primary central nervous system lymphoma

Authors
 Hyunsoo Cho  ;  Jong Hee Chang  ;  Yu Ri Kim  ;  Soo-Jeong Kim  ;  Haerim Chung  ;  Hyunsung Park  ;  Jung Yeon Lee  ;  Ji Eun Jang  ;  Yundeok Kim  ;  Se Hoon Kim  ;  Woo Ick Yang  ;  Chang-Ok Suh  ;  June-Won Cheong  ;  Yoo Hong Min  ;  Jin Seok Kim 
Citation
 British Journal of Haematology, Vol.174(3) : 444-453, 2016 
Journal Title
 British Journal of Haematology 
ISSN
 0007-1048 
Issue Date
2016
MeSH
Adult ; Age Factors ; Antineoplastic Combined Chemotherapy Protocols ; Central Nervous System Neoplasms/mortality ; Central Nervous System Neoplasms/therapy* ; Combined Modality Therapy/mortality ; Female ; Hematopoietic Stem Cell Transplantation/methods* ; Hematopoietic Stem Cell Transplantation/mortality ; Hematopoietic Stem Cell Transplantation/standards ; Humans ; Male ; Methotrexate/therapeutic use ; Middle Aged ; Remission Induction/methods ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Transplantation, Autologous ; Young Adult
Keywords
autologous stem cell transplantation ; chemotherapy ; overall survival ; primary central nervous system lymphoma ; progression-free survival
Abstract
Upfront autologous stem cell transplantation (ASCT) has shown favourable outcome in patients with primary central nervous system lymphoma (PCNSL), but the role of risk-adapted upfront ASCT consolidation has not been evaluated in PCNSL. As PCNSL patients with the International Extranodal Lymphoma Study Group (IELSG) prognostic score ≥2 or those who did not achieve complete response after two courses of induction chemotherapy (non-CR1) have shown inferior outcomes, we retrospectively analysed the role of upfront ASCT in 66 high-risk (IELSG ≥2 and/or non-CR1) younger (age <65 years) immunocompetent PCNSL patients who achieved at least partial response after initial high-dose methotrexate-based chemotherapy. Nineteen patients who received upfront ASCT exhibited significantly better overall survival (OS, P = 0·021) and progression-free survival (PFS, P = 0·005) compared to 47 patients who did not. In univariate and multivariate analyses, upfront ASCT was associated with better OS (P = 0·037 and P = 0·025, respectively) and PFS (P = 0·009 and P = 0·007, respectively). In a propensity score-matched cohort (n = 36), patients who received upfront ASCT also showed better outcome (P = 0·037 for OS, P = 0·001 for PFS). Our results suggest that upfront ASCT consolidation might be especially beneficial for high-risk PCNSL patients.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/bjh.14069/abstract
DOI
10.1111/bjh.14069
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Se Hoon(김세훈) ORCID logo https://orcid.org/0000-0001-7516-7372
Kim, Soo Jeong(김수정) ORCID logo https://orcid.org/0000-0001-8859-3573
Kim, Yu Ri(김유리) ORCID logo https://orcid.org/0000-0001-5505-0142
Kim, Yun Deok(김윤덕) ORCID logo https://orcid.org/0000-0002-5336-7936
Kim, Jin Seok(김진석) ORCID logo https://orcid.org/0000-0001-8986-8436
Min, Yoo Hong(민유홍) ORCID logo https://orcid.org/0000-0001-8542-9583
Park, Hyeun Sung(박현성)
Suh, Chang Ok(서창옥)
Yang, Woo Ick(양우익) ORCID logo https://orcid.org/0000-0002-6084-5019
Lee, Jung Yoen(이정연)
Chang, Jong Hee(장종희)
Jang, Ji Eun(장지은) ORCID logo https://orcid.org/0000-0001-8832-1412
Cheong, June-Won(정준원) ORCID logo https://orcid.org/0000-0002-1744-0921
Chung, Hae Rim(정해림) ORCID logo https://orcid.org/0000-0002-7926-9285
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/152760
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