High‐dose chemotherapy with autologus hematopoeitic stem cell transplantation in relapsing Vitreoretinal Lymphoma, a LOC network study

Abstract

PurposeThe management of isolated vitreoretinal lymphoma (VRL) remains controversial due to his rarity. The aim of this study was to evaluate the efficiency and safety of high‐dose chemotherapy with autologous hematopoietic stem cell transplantation (HCT‐ASCT) as a treatment of recurrent relapsing VRL.MethodsWe retrospectively studied medical records of patients included in the French LOC network database between 2011 and 2016 with isolated vitreoretinal relapse of either primary vitreoretinal lymphoma or oculocerebral lymphoma treated with HCT‐ASCT. Hematologic, neurologic and ophtalmologic datas were screened.Results32 patients (16 F/16 M), all immunocompetent, were included in the study. Median age at HCT‐ASCT was 62 (range 44–73 years). Median Karnofsky Performance status before HCT‐ASCT was 90. At diagnosis, 17/32 had primary vitreoretinous lymphoma (PVRL), 7/32 Primary Central Nervous Cells Lymphoma (PCNCL), 8/32 PVRL and PCNL. Patients had previously received a median number of 1 line of treatment including high‐dose methotrexate before HCT‐ASCT. All patients received a thiotepa‐based HCT. 81% of the patients experienced a complete response. 2 “toxic deaths” occurred. Mean follow‐up was 41.6 months (range: 5–96). 9/32 patients had recurrences. The 5‐years OS was 81%. The 5‐years OS was respectively 91% in the PRVRL groups, 85% in ocular and cerebral group and 64% in PCNCL group. The 5‐years PFS rate was 58%. The 5‐years PFS was respectively 66% in the PRVRL groups, 75% in ocular and cerebral group and 43% in PCNCL group. 4 deaths occurred overall.ConclusionsIntensive chemotherapy followed by autologous stem cell transplant is an aggressive therapeutic approach but appears to give interesting results especially in young and fit patients with recurrent refractory vitreoretinal lymphoma.