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Thiotepa, busulfan, and cyclophosphamide or busulfan, cyclophosphamide, and etoposide high-dose chemotherapy followed by autologous stem cell transplantation for consolidation of primary central nervous system lymphoma

  • Jaewon Hyung
  • Jung Yong Hong
  • Dok Hyun Yoon
  • Shin Kim
  • Jung Sun Park
  • Chan-sik Park
  • Sang-wook Lee
  • Jeong Hoon Kim
  • Jin Sook Ryu
  • Jooryung Huh
  • Cheolwon SuhEmail author
Original Article

Abstract

Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin lymphoma for which standard treatment has yet to be established. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a suitable consolidation strategy for patients who respond to induction chemotherapy. The purpose of this study was to compare the outcome and toxicity profile of the combination of busulfan, cyclophosphamide, and etoposide (BuCyE) with that of the combination of thiotepa, busulfan, and cyclophosphamide (TBC) as conditioning regimens of upfront ASCT for consolidation therapy in PCNSL. The PCNSL registry data set, prospectively collected from March 1993 to May 2017 at Asan Medical Center, was reviewed retrospectively. Patients with objective response to induction chemotherapy who received BuCyE or TBC as conditioning regimen for ASCT were included in the analysis. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Among 241 patients with a diagnosis of PCNSL, 53 received ASCT as upfront consolidation therapy with TBC (28 patients) or BuCyE (25 patients) as conditioning regimen. No median OS or PFS was reached in the TBC group, while the BuCyE group reached a median OS of 4.9 years (p = 0.02) and median PFS of 1.1 years (p = 0.007). The incidence of oral mucositis, nausea, and vomiting was higher with TBC than BuCyE. The median admission duration and days to engraftment were similar between the two groups. Despite the greater incidence of adverse events, TBC showed better outcomes than BuCyE in terms of survival.

Keywords

Primary central nervous system lymphoma Consolidation Autologous stem cell transplantation Thiotepa Busulfan Cyclophosphamide Etoposide 

Notes

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required (IRB 2018-1275).

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

277_2019_3667_MOESM1_ESM.pdf (182 kb)
ESM 1 (PDF 182 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jaewon Hyung
    • 1
  • Jung Yong Hong
    • 1
  • Dok Hyun Yoon
    • 1
  • Shin Kim
    • 1
  • Jung Sun Park
    • 1
  • Chan-sik Park
    • 2
  • Sang-wook Lee
    • 3
  • Jeong Hoon Kim
    • 4
  • Jin Sook Ryu
    • 5
  • Jooryung Huh
    • 2
  • Cheolwon Suh
    • 1
    Email author
  1. 1.Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Pathology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  3. 3.Department of Radiation Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  4. 4.Department of Neurological Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  5. 5.Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea

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