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International Journal of Hematology

, Volume 109, Issue 3, pp 260–277 | Cite as

Hematopoietic stem cell transplantation in primary central nervous system lymphoma: a review of the literature

  • Daria Gaut
  • Gary J. SchillerEmail author
Review Article

Abstract

Primary central nervous system lymphoma (PCNSL) is an uncommon variant of extranodal non-Hodgkin lymphoma (NHL) with an aggressive course and worse outcomes compared with other lymphomas of similar tumor burden and histologic subtype. High-dose chemotherapy supported by autologous stem cell transplantation (HDC/ASCT) is an option for therapy for this disease in both the relapse setting and as post-remission consolidation. Data are currently limited to only several single-arm phase II trials with small sample sizes, but randomized trials are now ongoing. In this review, we discuss the efficacy, feasibility, and toxicity of HDC/ASCT for PCNSL and its role in the treatment of this aggressive malignancy, both in the first-line and relapse settings. We also bring to attention the current data on allogeneic stem cell transplantation (allo-SCT) in PCNSL.

Keywords

Allogeneic stem cell transplantation Autologous stem cell transplantation Primary central nervous system lymphoma Progression-free survival Overall survival 

Abbreviations

Allo-HCT

Allogeneic stem cell transplantation

ATG

Anti-human thymocyte globulin

ASCT

Autologous stem cell transplantation

BBB

Blood–brain barrier

BEAM

Carmustine, etoposide, cytarabine, melphalan

CHOP

Cyclophosphamide, doxorubicin, vincristine, prednisone

CR

Complete remission

CRR

Complete remission rate

DLBCL

Diffuse large B-cell lymphoma

DFS

Disease-free survival

ECOG

Eastern Cooperative Oncology Group

EBV

Epstein–Barr virus

EFS

Event-free survival

GVHD

Graft versus host disease

HDC/ASCT

High-dose chemotherapy supported by autologous stem cell transplantation

CYVE

High-dose cytarabine and etoposide

HD-MTX

High-dose methotrexate

MBVP

Methotrexate, etoposide, carmustine, methylprednisone

NHL

Non-Hodgkin lymphoma

ORR

Objective response rate

OS

Overall survival

PCNSL

Primary central nervous system lymphoma

PFS

Progression-free survival

R-MPV

Rituximab, methotrexate, procarbazine, and vincristine

TBC

Thiotepa, busulfan, cyclophosphamide

WBRT

Whole-brain radiation therapy

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Hoffman S, Propp JM, McCarthy BJ. Temporal trends in incidence of primary brain tumors in the United States, 1985–1999. Neuro Oncol. 2006;8(1):27–37.  https://doi.org/10.1215/S1522851705000323.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Dolecek TA, Propp JM, Stroup NE, Kruchko C. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005–2009. Neuro Oncol. 2012;14(Suppl 5):v1–49.  https://doi.org/10.1093/neuonc/nos218. Suppl 5) .PubMedPubMedCentralGoogle Scholar
  3. 3.
    Jahnke K, Thiel E, Martus P, Herrlinger U, Weller M, Fischer L, et al. Relapse of primary central nervous system lymphoma: clinical features, outcome and prognostic factors. J Neurooncol. 2006;80(2):159–65.  https://doi.org/10.1007/s11060-006-9165-6.PubMedGoogle Scholar
  4. 4.
    Ferreri AJM, Reni M, Pasini F, Calderoni A, Tirelli U, Pivnik A, et al. A multicenter study of treatment of primary CNS lymphoma. Neurology. 2002;58(10):1513–20.PubMedGoogle Scholar
  5. 5.
    Kasenda B, Ferreri AJM, Marturano E, Forst D, Bromberg J, Ghesquieres H, et al. First-line treatment and outcome of elderly patients with primary central nervous system lymphoma (PCNSL)—a systematic review and individual patient data meta-analysis. Ann Oncol. 2015;26(7):1305–13.  https://doi.org/10.1093/annonc/mdv076.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Citterio G, Reni M, Gatta G, Ferreri AJM. Primary central nervous system lymphoma. Crit Rev Oncol Hematol. 2017;113:97–110.  https://doi.org/10.1016/J.CRITREVONC.2017.03.019.PubMedGoogle Scholar
  7. 7.
    Ferreri AJM. How I treat primary CNS lymphoma. Blood. 2011;118(3):510–22.  https://doi.org/10.1182/blood-2011-03-321349.PubMedGoogle Scholar
  8. 8.
    Langner-Lemercier S, Houillier C, Soussain C, Ghesquières H, Chinot O, Taillandier L, et al. Primary CNS lymphoma at first relapse/progression: characteristics, management, and outcome of 256 patients from the French LOC network. Neuro Oncol. 2016;18(9):1297–303.  https://doi.org/10.1093/neuonc/now033.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Thiel E, Korfel A, Martus P, Kanz L, Griesinger F, Rauch M, et al. High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma (G-PCNSL-SG-1): a phase 3, randomised, non-inferiority trial. Lancet Oncol. 2010;11(11):1036–47.  https://doi.org/10.1016/S1470-2045(10)70229-1.PubMedGoogle Scholar
  10. 10.
    Korfel A, Thiel E, Martus P, Griesinger F, Rauch M, Röth A, et al. Randomized phase III study of whole-brain radiotherapy for primary CNS lymphoma. Neurology. 2015;84(12):1242–8.  https://doi.org/10.1212/WNL.0000000000001395.PubMedGoogle Scholar
  11. 11.
    Rubenstein JL, Hsi ED, Johnson JL, Jung SH, Nakashima MO, Grant B, et al. Intensive chemotherapy and immunotherapy in patients with newly diagnosed primary CNS lymphoma: CALGB 50202 (Alliance 50202). J Clin Oncol. 2013;31(25):3061–8.  https://doi.org/10.1200/JCO.2012.46.9957.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Reni M, Ferreri AJ. Therapeutic management of refractory or relapsed primary central nervous system lymphomas. Ann Hematol. 2001;80(Suppl 3):B113–7.PubMedGoogle Scholar
  13. 13.
    Deangelis LM, Iwamoto FM. An update on therapy of primary central nervous system lymphoma. Hematol Am Soc Hematol Educ Progr. 2006;2006(1):311–6.  https://doi.org/10.1182/asheducation-2006.1.311.Google Scholar
  14. 14.
    Gerstner ER, Batchelor TT. Primary central nervous system lymphoma. Arch Neurol. 2010;67(3):291–7.  https://doi.org/10.1001/archneurol.2010.3.PubMedGoogle Scholar
  15. 15.
    Philip T, Guglielmi C, Hagenbeek A, Somers R, Van der Lelie H, Bron D, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-hodgkin’s lymphoma. N Engl J Med. 1995;333(23):1540–5.  https://doi.org/10.1056/NEJM199512073332305.PubMedGoogle Scholar
  16. 16.
    Soussain C, Suzan F, Hoang-Xuan K, Cassoux N, Levy V, Azar N, et al. Results of intensive chemotherapy followed by hematopoietic stem-cell rescue in 22 patients with refractory or recurrent primary CNS lymphoma or intraocular lymphoma. J Clin Oncol. 2001;19(3):742–9.  https://doi.org/10.1200/JCO.2001.19.3.742.PubMedGoogle Scholar
  17. 17.
    Soussain C, Hoang-Xuan K, Taillandier L, Fourme E, Choquet S, Witz F, et al. Intensive chemotherapy followed by hematopoietic stem-cell rescue for refractory and recurrent primary CNS and intraocular lymphoma: Société Française de Greffe de Moëlle Osseuse-Thérapie Cellulaire. J Clin Oncol. 2008;26(15):2512–8.  https://doi.org/10.1200/JCO.2007.13.5533.PubMedGoogle Scholar
  18. 18.
    Soussain C, Choquet S, Fourme E, Delgadillo D, Bouabdallah K, Ghesquières H, et al. Intensive chemotherapy with thiotepa, busulfan and cyclophosphamide and hematopoietic stem cell rescue in relapsed or refractory primary central nervous system lymphoma and intraocular lymphoma: a retrospective study of 79 cases. Haematologica. 2012;97(11):1751–6.  https://doi.org/10.3324/haematol.2011.060434.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Cote GM, Hochberg EP, Muzikansky A, Hochberg FH, Drappatz J, McAfee SL, et al. Autologous stem cell transplantation with thiotepa, busulfan, and cyclophosphamide (TBC) conditioning in patients with CNS involvement by non-hodgkin lymphoma. Biol Blood Marrow Transpl. 2012;18(1):76–83.  https://doi.org/10.1016/j.bbmt.2011.07.006.Google Scholar
  20. 20.
    Welch MR, Sauter CS, Matasar MJ, Faivre G, Weaver SA, Moskowitz CH, et al. Autologous stem cell transplant in recurrent or refractory primary or secondary central nervous system lymphoma using thiotepa, busulfan and cyclophosphamide. Leuk Lymphoma. 2015;56(2):361–7.  https://doi.org/10.3109/10428194.2014.916800.PubMedGoogle Scholar
  21. 21.
    Alimohamed N, Daly A, Owen C, Duggan P, Stewart DA. Upfront thiotepa, busulfan, cyclophosphamide, and autologous stem cell transplantation for primary CNS lymphoma: a single centre experience. Leuk Lymphoma. 2012;53(5):862–7.  https://doi.org/10.3109/10428194.2011.633250.PubMedGoogle Scholar
  22. 22.
    Choi MK, Kang ES, Kim DW, Ko YH, Seok H, Park JH, et al. Treatment outcome of relapsed/refractory primary central nervous system diffuse large B-cell lymphoma: a single-center experience of autologous stem cell transplantation. Int J Hematol. 2013;98(3):346–54.  https://doi.org/10.1007/s12185-013-1403-z.PubMedGoogle Scholar
  23. 23.
    Fischer L, Thiel E, Klasen H-A, Birkmann J, Jahnke K, Martus P, et al. Prospective trial on topotecan salvage therapy in primary CNS lymphoma. Ann Oncol. 2006;17(7):1141–5.  https://doi.org/10.1093/annonc/mdl070.PubMedGoogle Scholar
  24. 24.
    Reni M, Zaja F, Mason W, Perry J, Mazza E, Spina M, et al. Temozolomide as salvage treatment in primary brain lymphomas. Br J Cancer. 2007;96(6):864–7.  https://doi.org/10.1038/sj.bjc.6603660.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Arellano-Rodrigo E, López-Guillermo A, Bessell EM, Nomdedeu B, Montserrat E, Graus F. Salvage treatment with etoposide (VP-16), ifosfamide and cytarabine (Ara-C) for patients with recurrent primary central nervous system lymphoma. Eur J Haematol. 2003;70(4):219–24.PubMedGoogle Scholar
  26. 26.
    Nguyen PL, Chakravarti A, Finkelstein DM, Hochberg FH, Batchelor TT, Loeffler JS. Results of whole-brain radiation as salvage of methotrexate failure for immunocompetent patients with primary CNS lymphoma. J Clin Oncol. 2005;23(7):1507–13.  https://doi.org/10.1200/JCO.2005.01.161.PubMedGoogle Scholar
  27. 27.
    Reni M, Mazza E, Foppoli M, Ferreri AJM. Primary central nervous system lymphomas: salvage treatment after failure to high-dose methotrexate. Cancer Lett. 2007;258(2):165–70.  https://doi.org/10.1016/J.CANLET.2007.10.009.PubMedGoogle Scholar
  28. 28.
    Plotkin SR, Betensky RA, Hochberg FH, Grossman SA, Lesser GJ, Nabors LB, et al. Treatment of relapsed central nervous system lymphoma with high-dose methotrexate. Clin Cancer Res. 2004;10(17):5643–6.  https://doi.org/10.1158/1078-0432.CCR-04-0159.PubMedGoogle Scholar
  29. 29.
    Illerhaus G, Marks R, Ihorst G, Guttenberger R, Ostertag C, Derigs G, et al. High-dose chemotherapy with autologous stem-cell transplantation and hyperfractionated radiotherapy as first-line treatment of primary CNS lymphoma. J Clin Oncol. 2006;24(24):3865–70.  https://doi.org/10.1200/JCO.2006.06.2117.PubMedGoogle Scholar
  30. 30.
    Illerhaus G, Muller F, Feuerhake F, Schafer A-O, Ostertag C, Finke J. High-dose chemotherapy and autologous stem-cell transplantation without consolidating radiotherapy as first-line treatment for primary lymphoma of the central nervous system. Haematologica. 2008;93(1):147–8.  https://doi.org/10.3324/haematol.11771.PubMedGoogle Scholar
  31. 31.
    Ferreri AJM, Cwynarski K, Pulczynski EJ, Fox CP, Schorb E, Rosèe PL, et al. Effects on survival and neurocognitive functions of whole-brain radiotherapy (WBRT) and autologous stem cell transplantation (ASCT) as consolidation options after high-dose methotrexate-based chemoimmunotherapy in patients with newly diagnosed primary CNS lymphoma (PCNSL): results of the second randomization of the IELSG32 trial. Blood. 2016;128(22):511.Google Scholar
  32. 32.
    Illerhaus G, Kasenda B, Ihorst G, Egerer G, Lamprecht M, Keller U, et al. High-dose chemotherapy with autologous haemopoietic stem cell transplantation for newly diagnosed primary CNS lymphoma: a prospective, single-arm, phase 2 trial. Lancet Haematol. 2016;3(8):e388–97.  https://doi.org/10.1016/S2352-3026(16)30050-3.PubMedGoogle Scholar
  33. 33.
    Bojic M, Berghoff AS, Troch M, Agis H, Sperr WR, Widhalm G, et al. Haematopoietic stem cell transplantation for treatment of primary CNS lymphoma: single-centre experience and literature review. Eur J Haematol. 2015;95(1):75–82.  https://doi.org/10.1111/ejh.12482.PubMedGoogle Scholar
  34. 34.
    Alvarnas JC, Negrin RS, Horning SJ, Hu WW, Long GD, Schriber JR, et al. High-dose therapy with hematopoietic cell transplantation for patients with central nervous system involvement by non-Hodgkin’s lymphoma. Biol Blood Marrow Transpl. 2000;6(3A):352–8.Google Scholar
  35. 35.
    Montemurro M, Kiefer T, Schüler F, Al-Ali HK, Wolf HH, Herbst R, et al. Primary central nervous system lymphoma treated with high-dose methotrexate, high-dose busulfan/thiotepa, autologous stem-cell transplantation and response-adapted whole-brain radiotherapy: results of the multicenter Ostdeutsche Studiengruppe Hamato-Onkologie OSHO-53 phase II study. Ann Oncol. 2006;18(4):665–71.  https://doi.org/10.1093/annonc/mdl458.PubMedGoogle Scholar
  36. 36.
    Kiefer T, Hirt C, Späth C, Schüler F, Al-Ali HK, Wolf HH, et al. Long-term follow-up of high-dose chemotherapy with autologous stem-cell transplantation and response-adapted whole-brain radiotherapy for newly diagnosed primary CNS lymphoma: results of the multicenter Ostdeutsche Studiengruppe Hamatologie und Onkologie OSHO-53 phase II study. Ann Oncol. 2012;23(7):1809–12.  https://doi.org/10.1093/annonc/mdr553.PubMedGoogle Scholar
  37. 37.
    Yoon DH, Lee DH, Choi DR, Sohn BS, Kim S, Kim SW, et al. Feasibility of BU, CY and etoposide (BUCYE) and auto-SCT in patients with newly diagnosed primary CNS lymphoma: a single-center experience. Bone Marrow Transpl. 2011;46(1):105–9.  https://doi.org/10.1038/bmt.2010.71.Google Scholar
  38. 38.
    Kasenda B, Schorb E, Fritsch K, Finke J, Illerhaus G. Prognosis after high-dose chemotherapy followed by autologous stem-cell transplantation as first-line treatment in primary CNS lymphoma—a long-term follow-up study. Ann Oncol. 2012;23(10):2670–5.  https://doi.org/10.1093/annonc/mds059.PubMedGoogle Scholar
  39. 39.
    Abrey LE, Moskowitz CH, Mason WP, Crump M, Stewart D, Forsyth P, et al. Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma: an intent-to-treat analysis. J Clin Oncol. 2003;21(22):4151–6.  https://doi.org/10.1200/JCO.2003.05.024.PubMedGoogle Scholar
  40. 40.
    Miyao K, Sakemura R, Imai K, Sakai T, Tsushita N, Kato T, et al. Upfront autologous stem-cell transplantation with melphalan, cyclophosphamide, etoposide, and dexamethasone (LEED) in patients with newly diagnosed primary central nervous system lymphoma. Int J Hematol. 2014;100(2):152–8.  https://doi.org/10.1007/s12185-014-1608-9.PubMedGoogle Scholar
  41. 41.
    Scordo M, Bhatt V, Hsu M, Omuro AM, Matasar MJ, DeAngelis LM, et al. A comprehensive assessment of toxicities in patients with central nervous system lymphoma undergoing autologous stem cell transplantation using thiotepa, busulfan, and cyclophosphamide conditioning. Biol Blood Marrow Transpl. 2017;23(1):38–43.  https://doi.org/10.1016/j.bbmt.2016.09.024.Google Scholar
  42. 42.
    Brevet M, Garidi R, Gruson B, Royer B, Vaida I, Damaj G. First-line autologous stem cell transplantation in primary CNS lymphoma. Eur J Haematol. 2005;75(4):288–92.  https://doi.org/10.1111/j.1600-0609.2005.00508.x.PubMedGoogle Scholar
  43. 43.
    Colombat P, Lemevel A, Bertrand P, Delwail V, Rachieru P, Brion A, et al. High-dose chemotherapy with autologous stem cell transplantation as first-line therapy for primary CNS lymphoma in patients younger than 60 years: a multicenter phase II study of the GOELAMS group. Bone Marrow Transpl. 2006;38(6):417–20.  https://doi.org/10.1038/sj.bmt.1705452.Google Scholar
  44. 44.
    Omuro A, Correa DD, DeAngelis LM, Moskowitz CH, Matasar MJ, Kaley TJ, et al. R-MPV followed by high-dose chemotherapy with TBC and autologous stem-cell transplant for newly diagnosed primary CNS lymphoma. Blood. 2015;125(9):1403–10.  https://doi.org/10.1182/blood-2014-10-604561.PubMedPubMedCentralGoogle Scholar
  45. 45.
    DeFilipp Z, Li S, El-Jawahri A, Armand P, Nayak L, Wang N, et al. High-dose chemotherapy with thiotepa, busulfan, and cyclophosphamide and autologous stem cell transplantation for patients with primary central nervous system lymphoma in first complete remission. Cancer. 2017;123(16):3073–9.  https://doi.org/10.1002/cncr.30695.PubMedGoogle Scholar
  46. 46.
    Chen Y-B, Batchelor T, Li S, Hochberg E, Brezina M, Jones S, et al. Phase 2 trial of high-dose rituximab with high-dose cytarabine mobilization therapy and high-dose thiotepa, busulfan, and cyclophosphamide autologous stem cell transplantation in patients with central nervous system involvement by non-Hodgkin lymphoma. Cancer. 2015;121(2):226–33.  https://doi.org/10.1002/cncr.29023.PubMedGoogle Scholar
  47. 47.
    Houillier C, Taillandier L, Lamy T, Chinot O, Molucon-Chabrot C, Soubeyran P, et al. Whole brain radiotherapy (WBRT) versus intensive chemotherapy with haematopoietic stem cell rescue (IC + HCR) for primary central nervous system lymphoma (PCNSL) in young patients: an intergroup anocef-goelams randomized phase II trial (PRECIS). Blood. 2016;128(22):782.Google Scholar
  48. 48.
    Cheng T, Forsyth P, Chaudhry A, Morris D, Glück S, Russell JA, et al. High-dose thiotepa, busulfan, cyclophosphamide and ASCT without whole-brain radiotherapy for poor prognosis primary CNS lymphoma. Bone Marrow Transpl. 2003;31(8):679–85.  https://doi.org/10.1038/sj.bmt.1703917.Google Scholar
  49. 49.
    Puig N, De La Rubia J, Remigia MJ, Jarque I, Martín G, Cupelli L, et al. Morbidity and transplant-related mortality of CBV and BEAM preparative regimens for patients with lymphoid malignancies undergoing autologous stem-cell transplantation. Leuk Lymphoma. 2006;47(8):1488–94.  https://doi.org/10.1080/10428190500527769.PubMedGoogle Scholar
  50. 50.
    Lahoud OB, Sauter CS, Hamlin PA, Dahi PB. High-dose chemotherapy and autologous stem cell transplant in older patients with lymphoma. Curr Oncol Rep. 2015;17(9):42.  https://doi.org/10.1007/s11912-015-0465-x.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Wiebe VJ, Smith BR, DeGregorio MW, Rappeport JM. Pharmacology of agents used in bone marrow transplant conditioning regimens. Crit Rev Oncol Hematol. 1992;13(3):241–70.PubMedGoogle Scholar
  52. 52.
    Muldoon LL, Soussain C, Jahnke K, Johanson C, Siegal T, Smith QR, et al. Chemotherapy delivery issues in central nervous system malignancy: a reality check. J Clin Oncol. 2007;25(16):2295–305.  https://doi.org/10.1200/JCO.2006.09.9861.PubMedGoogle Scholar
  53. 53.
    Ferreri AJM, Illerhaus G. The role of autologous stem cell transplantation in primary central nervous system lymphoma. Blood. 2016;127(13):1642–9.  https://doi.org/10.1182/blood-2015-10-636340.PubMedGoogle Scholar
  54. 54.
    Schorb E, Kasenda B, Atta J, Kaun S, Morgner A, Hess G, et al. Prognosis of patients with primary central nervous system lymphoma after high-dose chemotherapy followed by autologous stem cell transplantation. Haematologica. 2013;98(5):765–70.  https://doi.org/10.3324/haematol.2012.076075.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Hande KR, Wedlund PJ, Noone RM, Wilkinson GR, Greco FA, Wolff SN. Pharmacokinetics of high-dose etoposide (VP-16-213) administered to cancer patients. Cancer Res. 1984;44(1):379–82.PubMedGoogle Scholar
  56. 56.
    Motl S, Zhuang Y, Waters CM, Stewart CF. Pharmacokinetic considerations in the treatment of CNS tumours. Clin Pharmacokinet. 2006;45(9):871–903.  https://doi.org/10.2165/00003088-200645090-00002.PubMedGoogle Scholar
  57. 57.
    Graul EH, Schaumlöffel E, Hundeshagen H, Wilmanns H, Simon G. Metabolism of radioactive cyclophosphamide. Animal tests and clinical studies. Cancer. 1967;20(5):896–9.PubMedGoogle Scholar
  58. 58.
    Wieduwilt MJ, Valles F, Issa S, Behler CM, Hwang J, McDermott M, et al. Immunochemotherapy with intensive consolidation for primary CNS lymphoma: a pilot study and prognostic assessment by diffusion-weighted MRI. Clin Cancer Res. 2012;18(4):1146–55.  https://doi.org/10.1158/1078-0432.CCR-11-0625.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Fraser E, Gruenberg K, Rubenstein JL. New approaches in primary central nervous system lymphoma. Chin Clin Oncol. 2015;4(1):11.  https://doi.org/10.3978/j.issn.2304-3865.2015.02.01.PubMedPubMedCentralGoogle Scholar
  60. 60.
    DeAngelis LM, Seiferheld W, Schold SC, Fisher B, Schultz CJ, Radiation Therapy Oncology Group Study 93 – 10. Combination chemotherapy and radiotherapy for primary central nervous system lymphoma: Radiation Therapy Oncology Group Study 93–10. J Clin Oncol. 2002;20(24):4643–8.  https://doi.org/10.1200/JCO.2002.11.013.PubMedGoogle Scholar
  61. 61.
    Morris PG, Correa DD, Yahalom J, Raizer JJ, Schiff D, Grant B, et al. Rituximab, methotrexate, procarbazine, and vincristine followed by consolidation reduced-dose whole-brain radiotherapy and cytarabine in newly diagnosed primary CNS lymphoma: final results and long-term outcome. J Clin Oncol. 2013;31(31):3971–9.  https://doi.org/10.1200/JCO.2013.50.4910.PubMedPubMedCentralGoogle Scholar
  62. 62.
    Bhatt VR. Allogeneic stem cell transplantation for non-hodgkin lymphoma. Curr Hematol Malig Rep. 2016;11(3):196–207.  https://doi.org/10.1007/s11899-016-0319-0.PubMedGoogle Scholar
  63. 63.
    Atilla E, Sahin U, Atilla PA, Merter M, Ozyurek E, Ceyhan K, et al. Allogeneic stem cell transplantation for relapsed primary central nervous system lymphoma: is it feasible? Hematol Oncol Stem Cell Ther. 2018.  https://doi.org/10.1016/J.HEMONC.2018.02.001.Google Scholar
  64. 64.
    Varadi G, Or R, Kapelushnik J, Naparstek E, Nagler A, Brautbar C, et al. Graft-versus-lymphoma effect after allogeneic peripheral blood stem cell transplantation for primary central nervous system lymphoma. Leuk Lymphoma. 1999;34(1–2):185–90.  https://doi.org/10.3109/10428199909083396.PubMedGoogle Scholar
  65. 65.
    Carson MJ, Doose JM, Melchior B, Schmid CD, Ploix CC. CNS immune privilege: hiding in plain sight. Immunol Rev. 2006;213:48–65.  https://doi.org/10.1111/j.1600-065X.2006.00441.x.PubMedPubMedCentralGoogle Scholar

Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  1. 1.Department of Medicine, David Geffen School of MedicineUniversity of California Los AngelesLos AngelesUSA
  2. 2.Hematological Malignancies/Stem Cell Transplantation Unit, Division of Hematology/Oncology, Department of Medicine, David Geffen School of MedicineUniversity of California Los AngelesLos AngelesUSA

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