High-dose therapy with hematopoietic cell transplantation for patients with central nervous system involvement by non-Hodgkin's lymphoma

Central nervous system (CNS) involvement by non-Hodgkin's lymphoma (NHL) ca rries a poor patient prognosis whether it occurs as a primary site of disea se or secondarily in patients with systemic disease. In a group of 481 pati ents undergoing high-dose therapy with hematopoietic cell transplantation ( HCT) for NHL, 15 patients (3.1%) were identified with CNS involvement. Two patients had primary CNS lymphoma, and 13 had secondary disease. All patien ts received intrathecal chemotherapy, and 13 received CNS radiotherapy befo re transplantation. Fourteen patients received systemic chemotherapy. At th e time of transplantation, both patients with primary CNS lymphoma and 8 pa tients with secondary disease had achieved a complete response, 3 patients had achieved a partial response, 1 had failed induction therapy, and I had progression of CNS disease before high-dose therapy. Fourteen patients rece ived carmustine, etoposide, and cyclophosphamide as the preparative regimen , and 1 patient received fractionated total body irradiation instead of car mustine. The 2 patients,vith primary CNS lymphoma were alive and free of di sease, 1 at 1085 days after HCT and I at 3704 days after HCT. The actuarial 5-year event-free survival (EFS) was 46% +/- 26%, and overall survival (OS ) was 41% +/- 28%. The median EFS and OS were 2.2 and 1.5 years, respective ly. Three patients experienced symptomatic memory loss or intellectual decl ine after therapy, 1 patient developed paraplegia, and 1 patient had a thro mbotic stroke 20 months after HCT. Despite treatment-related toxicities, 7 patients responding to quality-of-life questions at approximately 1 year af ter HCT gave their overall quality of life a median rating of 9 out of a po ssible 10 (range, 6-10). High-dose therapy with autologous HCT can produce extended EFS in patients with secondary CNS lymphoma and possibly in those with primary CNS NHL.