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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)

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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.

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Authors and Affiliations

  1. Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu University, Kajaanintie 50, P.O. Box 5000, 90014, Oulu, Finland

    Hanne Kuitunen, Susanna Tokola, Taina Turpeenniemi-Hujanen & Outi Kuittinen

  2. Department of Radiology, Oulu University Hospital, Oulu University, Oulu, Finland

    Topi Siniluoto & Matti Isokangas

  3. Department of Anaesthesiology, Oulu University Hospital, Oulu University, Oulu, Finland

    Eila Sonkajärvi & Seppo Alahuhta

  4. Department of Medicine Kuopio, Kuopio University Hospital, Kuopio, Finland

    Esa Jantunen & Tapio Nousiainen

  5. Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland

    Kaija Vasala

Authors
  1. Hanne Kuitunen
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  2. Susanna Tokola
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  3. Topi Siniluoto
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  4. Matti Isokangas
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Correspondence to Hanne Kuitunen.

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Kuitunen, H., Tokola, S., Siniluoto, T. et al. 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). J Neurooncol 131, 293–300 (2017). https://doi.org/10.1007/s11060-016-2293-8

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  • DOI: https://doi.org/10.1007/s11060-016-2293-8

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