High dose therapy (HDT) and autologous stem cell transplantation (ASCT) in diffuse large B cell lymphoma (DLBL) patients with secondary central nervous system (CNS) involvement

Abstract

6658 Background: The prognosis of patients with secondary CNS involvement in DLBL is universally poor. Although randomized studies have shown that ASCT improves survival in relapsed DLBL patients, limited data is available to ascertain its role in those with secondary CNS disease. In this single institution experience, we evaluated whether HDT with ASCT improved outcomes in DLBL patients with secondary CNS involvement. Methods: Our institutional database was searched for all cases of DLBL with pathologic confirmation of secondary CNS involvement diagnosed over the last 10 years. Patients receiving ASCT subsequent to CNS diagnosis were identified and a comprehensive chart review was done to obtain information regarding clinical characteristics, prognostic variables, treatment and outcomes. Similar information was also collected for the remaining DLBL patients with secondary CNS disease who did not receive ASCT. Results: 21 patients with DLBL and secondary CNS disease were identified. Of these, 6 patients received HDT with ASCT. The median age at diagnosis was 44 years (range 22–52 years) and 4 were male. 2 had International Prognostic Index (IPI) scores of 2, while 4 had IPI scores of 3 at diagnosis. 3 received directed CNS radiation therapy and 4 received intrathecal chemotherapy. The median time to CNS involvement from diagnosis was 3.5 months (range 0–11 months). Two patients had died at 7 and 10 months after the diagnosis of CNS disease while 4 (67%) patients are alive at 50 48, 46, and 22 months following diagnosis of CNS disease. One year survival from the time of CNS diagnosis was 67%. This compares favorably to the remaining 15 patients with DLBL and CNS involvement (0 % one year survival) and historic controls (mean survival 3.5 months)1. Conclusions: HDT with ASCT can potentially improve the long-term survival in DLBL patients with secondary CNS involvement and warrants further studies. 1Hoerni-Simon G. Oncology. 1987; 44(2):98–101. No significant financial relationships to disclose.