178: Improved Survival for Patients Undergoing Autologous Stem Cell Transplant in First or Later Remission for Primary CNS Lymphoma

Abstract

Background: Survival for patients with primary CNS lymphoma (PCNSL), in general, is poor with patients requiring frequent chemotherapy treatments or receiving whole-brain radiation therapy, which can potentially result in significant neurologic decline and dementia. Because of the improved survival of high risk patients with aggressive lymphoma undergoing autologous stem cell transplant (ASCT), we began ASCT for patients with PCNSL in first or later remission with chemotherapy sensitive disease. We now update the outcomes of patients who have had at least 100 day follow up post ASCT. Baseline Characteristics: Between June, 2000 and March, 2007, 16 patients underwent ASCT for PCNSL. Median age at transplant was 50 years old (range 30–67). Median number of prior treatments 2 (range 1–3). Median time from diagnosis to transplant was 7.5 months (range 2.9 to 75.8). Median International Extranodal Working Study Group Prognostic Score: 2 (range 0–3). Disease status at transplant: First CR 6 patients, later CR or PR 10 patients. Median follow up from diagnosis was 45 months. Results: Sixteen patients underwent ASCT for PCNSL and have a minimum of 100 days follow-up. All patients received BEAM conditioning. Median follow up post-transplant was 32 months (range 3–85 months). Eight patients have relapsed at a median of 217 days (range 40–1349). Of the patients who relapsed, two have died of disease progression and the remaining five are alive after additional therapy. Median overall survival from transplant has not been reached. Three year overall and event free survival from transplant are 82% and 53%, respectively. Median progression free survival from BMT was 45 months. Overall survival from diagnosis at 5 years was 83%. Conclusions: Although limited by patient selection and retrospective biases, this review suggests that ASCT for PCNSL demonstrates improved overall survival when compared to historical controls with similar PCNSL Prognostic Scores (2 year survival for patients from diagnosis with PS 2–3 was 48% in a prior published study). ASCT in first remission in patients with PCNSL appears promising and may limit the need for additional therapy which can be myelosuppressive or result in neurologic decline, secondary to radiation therapy, in patients who are appropriate candidates.