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

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. [ABSTRACT FROM AUTHOR]