Originally published as JCO Early Release 10.1200/JCO.2007.13.5533 on April 14 2008

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Intensive Chemotherapy Followed by Hematopoietic Stem-Cell Rescue for Refractory and Recurrent Primary CNS and Intraocular Lymphoma: Société Française de Greffe de Moëlle Osseuse-Thérapie Cellulaire

Carole Soussain, Khê Hoang-Xuan, Luc Taillandier, Emmanuelle Fourme, Sylvain Choquet, Francis Witz, Olivier Casasnovas, Brigitte Dupriez, Bertrand Souleau, Anne-Laure Taksin, Christian Gisselbrecht, Arnaud Jaccard, Antonio Omuro, Marc Sanson, Maud Janvier, Brigitte Kolb, Jean-Marc Zini, Véronique Leblond

From the Department of Hematology; Biostatistics Unit, Centre René Huguenin, Saint-Cloud; Departments of Neurology and Hematology, Hôpital Pitié-Salpétrière; Department of Hematology, Hôpital Lariboisière, Paris; Departments of Neurology and Hematology, Centre Hospitalier Universitaire (CHU), Nancy; Department of Hematology, CHU Dijon; Department of Hematology, CH Lens; Department of Hematology, Hôpital Militaire, Percy; Department of Hematology, Hôpital de Versailles, Versailles; Department of Hematology, Hôpital Saint-Louis, Paris; Department of Hematology, CHU, Limoges; and the Department of Hematology, CHU Reims, France

Corresponding author: Carole Soussain, MD, Centre René Huguenin, Service d'Hématologie, 35 rue Dailly, 92210 Saint-Cloud, France; e-mail: soussain{at}crh1.org

Purpose The prognosis of relapsing primary CNS lymphoma (PCNSL) is poor. We report the results of a prospective multicenter trial of intensive chemotherapy followed by autologous hematopoietic stem-cell rescue (IC + HCR) in immunocompetent adult patients with PCNSL or intraocular lymphoma (IOL) after failure of high-dose methotrexate-based treatment.

Patients and Methods Salvage treatment consisted of two cycles of high-dose cytarabine and etoposide (CYVE). Intensive chemotherapy combined thiotepa, busulfan, and cyclophosphamide. Forty-three patients (median age, 52 years; range, 23 to 65 years) were included, with relapse (n = 22), refractory disease (n = 17), or a partial response to first-line treatment (n = 4). The response to CYVE was not assessable in three cases because of treatment-related death. Twenty patients (47%) were chemosensitive to CYVE: 15 of them proceeded to IC + HCR. IC + HCR was also administered to 12 patients who did not respond to CYVE. All but one of the 27 patients who underwent IC + HCR entered complete remission.

Results With a median follow-up of 36 months, the median overall survival was 18.3 months in the overall population, and 58.6 months among patients who completed IC + HCR. The respective median progression-free survival (PFS) times after IC + HCR were 11.6 and 41.1 months. The 2-year overall survival probability was 45% in the whole population and 69% among the 27 patients who received IC + HCR. The 2-year PFS probability was 43% among all the patients and 58% in the IC + HCR subpopulation.

Conclusion IC + HCR is an effective treatment for refractory and recurrent PCNSL.

published online ahead of print at www.jco.org on April 14, 2008

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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