Autologous haematopoietic cell transplantation for non-Hodgkin lymphoma with secondary CNS involvement.
Pre-existing central nervous system (CNS) involvement may influence referral for autologous haematopoietic cell transplantation (AHCT) for patients with non-Hodgkin lymphoma (NHL). The outcomes of 151 adult patients with NHL with prior secondary CNS involvement (CNS(+) ) receiving an AHCT were compared to 4688 patients without prior CNS lymphoma (CNS(-) ). There were significant baseline differences between the cohorts. CNS(+) patients were more likely to be younger, have lower performance scores, higher age-adjusted international prognostic index scores, more advanced disease stage at diagnosis, more aggressive histology, more sites of extranodal disease, and a shorter interval between diagnosis and AHCT. However, no statistically significant differences were identified between the two groups by analysis of progression-free survival (PFS) and overall survival (OS) at 5 years. A matched pair comparison of the CNS(+) group with a subset of CNS(-) patients matched on propensity score also showed no differences in outcomes. Patients with active CNS lymphoma at the time of AHCT (n = 55) had a higher relapse rate and diminished PFS and OS compared with patients whose CNS lymphoma was in remission (n = 96) at the time of AHCT. CNS(+) patients can achieve excellent long-term outcomes with AHCT. Active CNS lymphoma at transplant confers a worse prognosis.
Maziarz, RT; Wang, Z; Zhang, M-J; Bolwell, BJ; Chen, AI; Fenske, TS; Freytes, CO; Gale, RP; Gibson, J; Hayes-Lattin, BM; Holmberg, L; Inwards, DJ; Isola, LM; Khoury, HJ; Lewis, VA; Maharaj, D; Munker, R; Phillips, GL; Rizzieri, DA; Rowlings, PA; Saber, W; Satwani, P; Waller, EK; Maloney, DG; Montoto, S; Laport, GG; Vose, JM; Lazarus, HM; Hari, PN
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