Treatment with methotrexate, rituximab, and cytosine arabinoside followed by autologous stem cell transplantation in primary central nervous system lymphoma: A single-center experience

• Main Authors: Pinar Ataca Atilla, Erden Atilla, Sinem Civriz Bozdag, Meltem Kurt Yuksel, Selami Kocak Toprak, Pervin Topcuoglu, Taner Demirer, Osman Ilhan, Onder Arslan, Gunhan Gurman, Muhit Ozcan
• Format: Article
• Language: English
• Published: Elsevier 2018-03-01
• Series: Hematology/Oncology and Stem Cell Therapy
• Online Access: http://www.sciencedirect.com/science/article/pii/S1658387617300857

Objective/Background: Primary central nervous system lymphoma (PCNSL) is associated with worst prognosis compared with other aggressive non-Hodgkin’s lymphomas. However, recent trials have demonstrated that long-term progression-free survival can be achieved by immunochemotherapy. Our goal is to present our experience in aggressive PCNSL in this study. Methods: We retrospectively evaluated the clinical features and management of 13 PCNSL patients who were diagnosed and treated between 2006 and 2015. Results: Nine patients received rituximab (R) 375 mg/m2/day on Day 1, methotrexate (MTX) 3.5 g/m2/day and cytosine arabinoside (ARA-C) 4.4 g/m2/day on Day 2, as well as ARA-C 4.4 g/m2/day on Day 3 every 28 days, and underwent autologous stem cell transplantation. Two patients received procarbazine instead of ARA-C. One patient relapsed, and allogeneic hematopoietic stem cell transplantation was performed. All nine patients are followed in complete remission. Two of 13 patients received one course of MTX and 36–45 Gy radiotherapy and died. One patient with renal transplantation had progressive disease and died. Grade 3–4 hematological toxicity was detected in 11 (85%), Grade 3–4 mucositis in 11 (85%), and febrile neutropenia in 12 (92%) patients. The median overall survival in the R–MTX–ARA-C/procarbazine group was 28 ± 16 months. Conclusion: R–MTX–ARA-C followed by autologous stem cell transplantation seems a promising strategy with high response rates in PCNSL. Keywords: Autologous stem cell transplantation, Cytosine arabinoside, Methotrexate, Primary central nervous system lymphoma, Rituximab