Autologous haematopoietic cell transplantation for non-Hodgkin lymphoma with secondary CNS involvement

• Type of Material: Article
• Authors: Edmund Waller, Emory University; Hanna Khoury, Emory University; Richard T. Maziarz, Oregon Health & Science University, Portland; Zhiwei Wang, Medical College of Wisconsin; Mei-Jie Zhang, Medical College of Wisconsin; Brian J. Bolwell, Cleveland Clinic Foundation; Andy I. Chen, Oregon Health & Science University, Portland; Timothy S. Fenske, Medical College of Wisconsin; Cesar O. Freytes, University of Texas; Robert Peter Gale, Imperial College; John Gibson, Royal Prince Alfred Hospital Institute of Haematology, Sydney; Brandon M. Hayes-Lattin, Oregon Health & Science University; Leona Holmberg, Fred Hutchinson Cancer Research Center, Seattle; David J. Inwards, Mayo Clinic; Luis M Isola, Mount Sinai School of Medicine; Victor A. Lewis, Alberta Children’s Hospital, Calgary; Dipnarine Maharaj, South Florida Bone Marrow Stem Cell Institute; Reinhold Munker, Louisiana State University; Gordon L. Phillips, University of Rochester; David A. Rizzieri, Duke University; Philip A. Rowlings, University of Newcastle; Wael Saber, Medical College of Wisconsin; Prakash Satwani, Columbia University; David G. Maloney, Fred Hutchinson Cancer Research Center, Seattle; Silvia Montoto, Barts Cancer Institute, London; Ginna G. Laport, Stanford University; Julie M. Vose, The Nebraska Medical Center; Hillard M. Lazarus, University Hospitals Case Medical Center; Parameswaran N. Hari, Medical College of Wisconsin
• Language: English
• Date: 2013-09-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 John Wiley & Sons Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1111/bjh.12451
• Title of Journal or Parent Work: British Journal of Haematology
• ISSN: 0007-1048
• Volume: 162
• Issue: 5
• Start Page: 648
• End Page: 656
• Grant/Funding Information: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA76518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U01HL069294 from NHLBI and NCI; a contract HHSH234200637015C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-06-1-0704 and N00014-08-1-0058 from the Office of Naval Research; and grants from Allos, Inc.; Amgen, Inc.; Angioblast; Anonymous donation to the Medical College of Wisconsin; Ariad; Be the Match Foundation; Blue Cross and Blue Shield Association; Buchanan Family Foundation; CaridianBCT; Celgene Corporation; CellGenix, GmbH; Children’s Leukemia Research Association; Fresenius-Biotech North America, Inc.; Gamida Cell Teva Joint Venture Ltd.; Genentech, Inc.; Genzyme Corporation; GlaxoSmithKline; HistoGenetics, Inc.; Kiadis Pharma; The Leukemia & Lymphoma Society; The Medical College of Wisconsin; Merck & Co, Inc.; Millennium: The Takeda Oncology Co.; Milliman USA, Inc.; Miltenyi Biotec, Inc.; National Marrow Donor Program; Optum Healthcare Solutions, Inc.; Osiris Therapeutics, Inc.; Otsuka America Pharmaceutical, Inc.; RemedyMD; Sanofi; Seattle Genetics; Sigma-Tau Pharmaceuticals; Soligenix, Inc.; StemCyte, A Global Cord Blood Therapeutics Co.; Stemsoft Software, Inc.; Swedish Orphan Biovitrum; Tarix Pharmaceuticals; Teva Neuroscience, Inc.; THERAKOS, Inc.; and Wellpoint, Inc.
• Keywords: central nervous system involvement; Science & Technology; Life Sciences & Biomedicine; outcomes; RELAPSE; HIGH-DOSE THERAPY; autologous transplantation; BONE-MARROW-TRANSPLANTATION; CENTRAL-NERVOUS-SYSTEM; INTRATHECAL RITUXIMAB; RECURRENCE; CHEMOTHERAPY; non-Hodgkin lymphoma; Hematology; IMPACT; RISK-FACTORS; BLOOD
• Research Categories: Health Sciences, Pharmacology; Biology, Neuroscience; Health Sciences, Oncology

Abstract

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.