PCNSL

EBMT 2018 | Thiotepa-based ASCT is safe and effective in CNS and non-CNS lymphoma

An oral session on lymphoma took place at the 44th European Society for Blood and Marrow Transplantation (EBMT) annual meeting on 19 March 2018. Abstract OS1-8 was presented by Herbert G. Sayer, chief doctor at the Helios Hospital Erfurt, Germany on the use of thiotepa-based autologous stem cell transplantation (ASCT) in primary central nervous system lymphoma (PCNSL), secondary central nervous system lymphoma (SCNSL), and non-CNS lymphoma.    

Study Overview
  • 66 patients were included in the study (median age 59, range 22–78) in this prospective, multi-center, non-interventional trial between October 2013 and April 2017
  • Patients with PCNSL (n = 26), SCNSL (n = 12), or non-CNS lymphoma (n = 28) received a thiotepa-containing high-dose chemotherapy (HDC) regimen prior to ASCT
  • The HDC regimens were either thiotepa 20 mg/kg, carmustine (BCNU) 400 mg/m2 with or without etoposide 450 mg/m2 (TBE) or thiotepa 10 mg/kg, cytarabine 1600 mg/m2, etoposide 800 mg/m2 and melphalan 140 mg/m2 (TEAM)
  • The primary endpoints were toxicity and efficacy
Key Findings
  • Most frequent adverse events grade 3-4 included mucositis (60.4%) and infection (45%)
  • Five deaths occurred due to therapy-related mortality at Day 100 follow-up; sepsis n = 3, pneumonia n = 1 and multi-organ failure n = 1
  • Response at Day 100 follow-up included 59 patients; complete remission n = 52.4%, partial remission n = 42.4% and stable disease n = 5.1%
  • Relapse or progression occurred in 21.2% of patients within the first year
  • 1-year progression-free survival (PFS)
    • PCNSL = 80.1%
    • SCNSL = 58.3%
    • Non-CNS = 66%
  • With regards to the two HDC regimes, there was 73.1% 1-year PFS in patients receiving TBE and 65.7% 1-year PFS in patients receiving TEAM
  • 1-year overall survival (OS)
    • PCNSL = 84.1%
    • SCNSL = 66.7%
    • Non-CNS = 70%
  • Additionally, there was 78.5% 1-year OS in patients receiving TBE and 73.4% 1-year OS in patients receiving TEAM

Dr. Sayer concluded that these early study results demonstrated promise for thiotepa-based HDC in terms of efficacy for CNS and non-CNS lymphoma with an acceptable safety profile.

References
  1. Sayer GH. et al. Thiotepa-based autologous hematopoietic stem cell transplantation (ASCT) for CNS or non-CNS lymphoma: First results of a prospective, multicentre, non-interventional study. Oral abstract OS1-8. EBMT 44th Annual Meeting, Lisbon, Portugal
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