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High-Dose Chemotherapy for Primary Central Nervous System Lymphoma
Outcomes for primary central nervous system lymphoma (PCNSL) have been improved via intensive immunochemotherapy plus autologous stem-cell transplantation (ASCT) consolidation, although clinicians have been concerned that older patients cannot benefit from this regimen due to underlying comorbidities and treatment-related toxicities. In MARTA, a phase 2, prospective, single-arm, German multicenter trial, researchers investigated the use of CNS-penetrating high-dose therapy and ASCT consolidation in 54 fit patients 65 years or older with newly diagnosed PCNSL. Eligible patients received two cycles of high-dose methotrexate and cytarabine plus rituximab, followed by a conditioning regimen of rituximab, thiotepa, and busulfan and then by ASCT rescue.
In the 51 evaluable patients, the 12-month progression-free survival (the primary endpoint) was 58.8%, but this did not meet the statistical threshold for efficacy. The 1-year overall survival was 80.6% among the 36 patients completing study treatment. At a median follow-up of 23 months, 23 patients (45%) had progression or relapse of disease or had died. Seven deaths occurred during induction and consolidation; three were considered treatment-related.
Comment
These findings from MARTA suggest that carefully selected, older PCNSL patients treated at specialized centers can benefit from high-dose chemotherapy and ASCT. The considerable need for effective treatment remains unmet among both younger and older patients with significant comorbidities and among those whose disease relapses or is refractory to initial therapy. Promising early data have led to an ongoing clinical trial exploring the integration of targeted agents plus immunochemotherapy (TEDDI-R regimen). I strongly recommend referral of PCNSL patients to a center with expertise and clinical trial opportunities for this rare lymphoma.
Citation(s)
Author:
Schorb E et al.
Title:
High-dose chemotherapy and autologous haematopoietic stem-cell transplantation in older, fit patients with primary diffuse large B-cell CNS lymphoma (MARTA): A single-arm, phase 2 trial.
Source:
Lancet Haematol
2024
Mar
; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Michael E. Williams, MD, ScM