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Outcomes Associated With Thiotepa-Based Conditioning in Patients With Primary Central Nervous System Lymphoma After Autologous Hematopoietic Cell Transplant

Authors :
Kwang Woo Ahn
Mohamed A. Kharfan-Dabaja
Nirav N. Shah
Farhad Khimani
Praveen Ramakrishnan Geethakumari
Sairah Ahmed
Yue Chen
Sachiko Seo
Nilanjan Ghosh
Narendranath Epperla
Mehdi Hamadani
Sanghee Hong
Amer Beitinjaneh
Pashna N. Munshi
Tim Prestidge
Leona Holmberg
Victor A. Chow
Michael Scordo
Yago Nieto
Natalie S Grover
Umar Farooq
Nada Hamad
Reem Karmali
Gerhard C. Hildebrandt
Andrew R. Rezvani
Jean A. Yared
Antonio Jimenez-Jimenez
Maxwell M. Krem
Bhagirathbhai Dholaria
Evgeny Klyuchnikov
Craig S. Sauter
David J. Inwards
Peter A. Riedell
Trent P Wang
Farrukh T. Awan
Alex F. Herrera
Andy I. Chen
Melhem Solh
Vaishalee P. Kenkre
Source :
JAMA Oncol
Publication Year :
2021

Abstract

IMPORTANCE: Primary central nervous system lymphoma (PCNSL) requires induction and consolidation to achieve potential cure. High-dose therapy and autologous hematopoietic cell transplant (AHCT) is an accepted and effective consolidation strategy for PCNSL, but no consensus exists on the optimal conditioning regimens. OBJECTIVE: To assess the outcomes in patients with PCNSL undergoing AHCT with the 3 most commonly used conditioning regimens: thiotepa/busulfan/cyclophosphamide (TBC), thiotepa/carmustine (TT-BCNU), and carmustine/etoposide/cytarabine/melphalan (BEAM). DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study used registry data from the Center for International Blood and Marrow Transplant Research registry. The Center is a working group of more than 380 transplantation centers worldwide that contributed detailed data on HCT to a statistical center at the Medical College of Wisconsin, Milwaukee. The participant data were from 603 adult patients with PCNSL who underwent AHCT as initial, or subsequent, consolidation between January 2010 and December 2018. Patients were excluded if they had a non-Hodgkin lymphoma subtype other than diffuse large B-cell lymphoma, systemic non-Hodgkin lymphoma, or HIV; received an uncommon conditioning regimen; or were not in partial remission or complete remission prior to AHCT. Statistical analysis was performed from July 5, 2020, to March 1, 2021. INTERVENTIONS: Patients received 1 of 3 conditioning regimens: TBC (n = 263), TT-BCNU (n = 275), and BEAM (n = 65). MAIN OUTCOMES AND MEASURES: The primary outcome was progression-free survival. Secondary outcomes included hematopoietic recovery, incidence of relapse, nonrelapse mortality, and overall survival. RESULTS: Of 603 patients, the mean age was 57 (range, 19-77) years and 318 (53%) were male. The 3-year adjusted progression-free survival rates were higher in the TBC cohort (75%) and TT-BCNU cohort (76%) compared with the BEAM cohort (58%) (P = .03) owing to a higher relapse risk in the BEAM cohort (hazard ratio [HR], 4.34; 95% CI, 2.45-7.70; P

Details

ISSN :
23742445
Volume :
7
Issue :
7
Database :
OpenAIRE
Journal :
JAMA oncology
Accession number :
edsair.doi.dedup.....f5f4b15a9fb6925afd65deff9506869e