AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR PATIENTS WITH NON-HODGKINS-LYMPHOMA AND CNS INVOLVEMENT - THOSE TRANSPLANTED WITH ACTIVE CNS DISEASE HAVE A POOR OUTCOME - A REPORT BY THE EUROPEAN BONE-MARROW TRANSPLANT LYMPHOMA REGISTRY

Purpose: CNS involvement of non-Hodgkin's lymphoma (NHL) has always be en considered a poor prognostic factor in relation to survival with co nventional therapy. However, its effect on the outcome of autologous b one marrow transplantation (ABMT) has not been assessed. We examined t his using data from the European Bone Marrow Transplant (EBMT) Lymphom a Registry. Patients and Methods: One thousand four hundred sixty-four patients with NHL have been reported to the EBMT registry, of whom 62 had CNS involvement. Patients were divided into those who were clear of CNS disease at the time of ABMT and those who were not. Response, c omplications, and outcome to ABMT were analyzed, as were details of CN S diagnosis, treatment, and prophylaxis. Results: Status at transplant was the only factor that significantly affected outcome of ABMT on un ivariate analysis (P = .03). The progression-free survival (PFS) rate of the group that had no CNS involvement at ABMT was 42% at 5 years, c ompared with 27% in a group of stage IV NHL patients without CNS disea se (matched for status at transplant and histology). There were four o f 45 (8.9%) toxic deaths, The PFS rate of the group that had CNS invol vement at ABMT was 9% at a median follow-up time of 71 months, which w as significantly different (P = .001) from that of the other group. Th ere were five of 17 (29.4%) toxic deaths (P = .043). patients who had CNS involvement at diagnosis, as compared with relapse, and those trea ted with both intrathecal chemotherapy and irradiation had a better ou tcome. Conclusion: The presence of CNS disease before ABMT but not pre sent at transplant does not adversely affect the outcome of ABMT. In c ontrast, patients with CNS involvement at the time of ABMT have a poor prognosis, although a small number survive in complete remission (CR) .