High-dose thiotepa, XXXX , @entity786 and ASCT without whole-brain radiotherapy for poor prognosis primary CNS lymphoma.

@entity1 @entity322 @entity66 @entity303 @entity2055 @entity149 @entity786 @entity2033 @entity1500 @entity1863 @entity1499 @entity204 @entity2359
Treatment of @entity149 ( @entity149 ) with combined high-dose @entity1499 ( @entity2033 - @entity1500 )-based chemotherapy and whole-brain radiotherapy (WBRT) is associated with severe @entity2359 , but high relapse rates are associated with the use of either modality alone. In an attempt to improve upon these dismal results, we treated seven @entity149 @entity1 with @entity2033 - @entity1500 -based induction therapy followed by thiotepa, @entity1863 , @entity786 (TBC), and autologous stem cell transplant (ASCT), without WBRT. Six of these @entity1 had at least one of the following poor prognostic features: Karnofsky performance status (KPS) <or=50%, age >60 years, or @entity66 . All but one @entity1 tolerated the treatment well and experienced improvements in neurological function and overall performance status post-transplant. No treatment-induced @entity2359 ( @entity303 , @entity2055 , and @entity322 ) was observed although the follow-up is short. One early treatment-related @entity204 occurred in a @entity1 with multiple comorbid medical conditions. The other six @entity1 achieved a complete response (CR) after TBC and ASCT. Five @entity1 are currently alive and relapse-free at 5, 8, 24, 36, and 42 months from diagnosis. One additional @entity1 relapsed and died 33 months after diagnosis. Two of the seven @entity1 received TBC/ASCT as the only treatment after disease progression following their initial chemotherapy and both remain relapse-free at the time of this report, 22 and 31 months post-TBC/ASCT. In conclusion, prolonged CR can be attained after chemotherapy-only treatment of poor prognosis @entity149 . Furthermore, this small series suggests that high-dose chemotherapy for @entity149 should include drugs that penetrate the CNS such as @entity1863 and thiotepa rather than standard lymphoma regimens such as BEAM.
