Brief Summary
This study investigates the long-term outcomes of patients with primary central nervous system lymphoma (PCNSL) treated with a specific chemotherapy regimen followed by high-dose chemotherapy and autologous stem cell transplant (HDC-ASCT). The study found that HDC-ASCT was well-tolerated, with stable neurological function and no disease recurrence beyond 2 years after the transplant. The study also found that patients with poorer neurological function at long-term follow-up were older at the time of enrollment.
- HDC-ASCT was well-tolerated with stable neurological function and no disease recurrence beyond 2 years.
- Older patients had poorer neurological function at long-term follow-up.
Patient Characteristics
This chapter describes the characteristics of the patients enrolled in the study. A total of 33 patients were initially enrolled, but one was removed due to systemic involvement. The remaining 32 patients received the intended treatment, with 26 ultimately receiving HDC-ASCT. The median age of the study population was 52 years, and approximately 47% were women. There were no major differences between patients who received HDC-ASCT and those who did not.
Progression-Free Survival and Overall Survival
This chapter presents the long-term survival data for the patients. Of the 26 patients who received HDC-ASCT, 3 died within the first 2 years due to treatment-related toxicity, and 2 died from disease progression. The remaining 21 patients had no disease progression with a median follow-up of 12.1 years. The median progression-free survival (PFS) and overall survival (OS) were not reached, with 5-year PFS and OS rates of 78% and 81.3%, respectively. Notably, no disease recurrence or death was observed beyond 2 years after HDC-ASCT.
KPS and NANO Scores
This chapter examines the Karnofsky Performance Status (KPS) and Neurologic Assessment in Neuro-Oncology (NANO) scores of the patients. The median KPS improved from 80 after HDC-ASCT to 90 at the last follow-up. The median NANO score remained stable at 1 after HDC-ASCT and decreased to 0 at the last follow-up. Interestingly, patients with higher NANO scores at the last follow-up were older at trial enrollment.
Leukoencephalopathy Scores
This chapter focuses on the leukoencephalopathy scores of the patients. Leukoencephalopathy is a condition that affects the white matter of the brain and can be a side effect of certain treatments. The median modified Fazekas leukoencephalopathy scale score remained stable at 1 from post-HDC-ASCT to the last follow-up. While some patients experienced mild worsening of their leukoencephalopathy, they remained functionally independent. Similar to the NANO score, patients with higher leukoencephalopathy scores at the last follow-up were older at trial enrollment.
Discussion
This chapter discusses the findings of the study and compares them to previous research. The study's long-term follow-up data suggest that HDC-ASCT is a well-tolerated and effective treatment option for PCNSL, with excellent long-term disease control. The study also highlights the importance of considering age as a potential factor influencing long-term neurological function. The authors acknowledge the limitations of the study, including the small sample size and single-institution experience. They suggest that further research with larger, multicenter trials is needed to confirm these findings.
Glossary
This section provides definitions for the acronyms and technical terms used in the study:
- ASCT: Autologous stem cell transplant
- CR: Complete response
- FLAIR: Fluid-attenuated inversion recovery
- HDC: High-dose chemotherapy
- KPS: Karnofsky Performance Status
- NANO: Neurologic Assessment in Neuro-Oncology
- OS: Overall survival
- PCNSL: Primary CNS lymphoma
- PD: Progressive disease
- PFS: Progression-free survival
- PR: Partial response
- R-MVP: Rituximab, methotrexate, vincristine, and procarbazine
- SD: Stable disease
