IMPACT OF PREEXISTING CNS INVOLVEMENT ON THE OUTCOME OF BONE-MARROW TRANSPLANTATION IN ADULT HEMATOLOGIC MALIGNANCIES

Purpose: To determine the impact of prior or current CNS disease on th e outcome of high-dose chemotherapy for patients with hematologic mali gnancies. Patients and Methods: In a 54-month period, 373 patients wit h hematologic malignancies underwent allogeneic or autologous bone mar row transplantation (BMT) or blood stem-cell transplantation using hig h-dose thiotepa, busulfan, and cyclophosphamide (TBC) as the preparati ve regimen. Four patients with active CNS disease at BMT and 20 patien ts with a history of prior CNS disease were identified. The outcomes o f those with a history of CNS disease were compared with those of a ma tched control group. Results: Of four patients with active CNS disease at the time of BMT, two had CNS recurrences and one recurred in the b one marrow. One patient died of treatment-related toxicity, Four of 20 patients with prior CNS involvement currently remain free of disease. At 2 years, the disease-free survival (DFS) rate was 23%+/-19%, and t he DFS rate for the control group 39%+/-24% (P=.053). An increased rat e of treatment-related toxicity and especially grades II to IV CNS tox icity accounted for the poorer outcome of patients who had a history o f CNS disease. Recurrence rates were not significantly different betwe en the two groups, Prior radiation to the CNS correlated with CNS comp lications posttransplant (P=.01). Conclusion: Consolidation with TBC a nd BMT can induce prolonged DFS in a proportion of patients with a his tory of CNS disease. Such patients are at increased risk for CNS compl ications that lead to an inferior overall outcome when compared with a control group. (C) 1996 by American Society of Clinical Oncology.