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Journal of Neuro-Oncology

, Volume 131, Issue 2, pp 293–300 | Cite as

Promising treatment results with blood brain barrier disruption (BBBD) based immunochemotherapy combined with autologous stem cell transplantation (ASCT) in patients with primary central nervous system lymphoma (PCNSL)

  • Hanne Kuitunen
  • Susanna Tokola
  • Topi Siniluoto
  • Matti Isokangas
  • Eila Sonkajärvi
  • Seppo Alahuhta
  • Taina Turpeenniemi-Hujanen
  • Esa Jantunen
  • Tapio Nousiainen
  • Kaija Vasala
  • Outi Kuittinen
Clinical Study

Abstract

Primary central nervous system lymphoma (PCNSL) is a rare brain tumour with a dismal prognosis. Several phase II studies with high-dose methotrexate-based regimens have shown promising early results, but in all hospital-based data published so far, the disease outcome has been poor. Patients with relapsed or refractory disease have a dismal prognosis. We performed retrospective analysis to evaluate results and tolerabilities of BBBD therapy in combination with high-dose therapy supported by autologous stem cell transplantation. We analysed 25 patients (age range: 40–71 years) who were treated in first or second line with BBBD therapy. When we started BBBD treatment, patients had relapsed or refractory PCNSL or they did not tolerate Bonn-like therapy. In recent years, some of the patients were treated in first line. We found promising response rates. Altogether 19 (76 %) of the patients achieved a complete response (CR). Two-year progression-free survival (PFS) and overall survival (OS) rates were 61 and 57 % respectively and the five-year OS was 47 %. Patients who were treated with a five-drug therapy had a very promising prognosis. The CR rate was 100 % in first-line therapy and 60 % in relapsed cases. These findings suggest that BBBD is a promising therapy for PCNSL, especially for patients in first line, but also for patients with relapsed or refractory disease after conventional chemotherapy, who commonly have a very poor prognosis. Treatment-related toxicity was generally manageable. Thus, BBBD followed by ASCT could be a treatment of choice in transplant-eligible patients with PCNSL.

Keywords

Primary central nervous system lymphoma Prognosis BBBD therapy 

Notes

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Hanne Kuitunen
    • 1
  • Susanna Tokola
    • 1
  • Topi Siniluoto
    • 2
  • Matti Isokangas
    • 2
  • Eila Sonkajärvi
    • 3
  • Seppo Alahuhta
    • 3
  • Taina Turpeenniemi-Hujanen
    • 1
  • Esa Jantunen
    • 4
  • Tapio Nousiainen
    • 4
  • Kaija Vasala
    • 5
  • Outi Kuittinen
    • 1
  1. 1.Department of Oncology and Radiotherapy, Oulu University HospitalOulu UniversityOuluFinland
  2. 2.Department of Radiology, Oulu University HospitalOulu UniversityOuluFinland
  3. 3.Department of Anaesthesiology, Oulu University HospitalOulu UniversityOuluFinland
  4. 4.Department of Medicine KuopioKuopio University HospitalKuopioFinland
  5. 5.Department of OncologyCentral Hospital of Central FinlandJyväskyläFinland

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