NHL with central nervous system involvement: Autologous stem cell transplant after high-dose chemotherapy an effective treatment option

This study examined outcomes of autologous stem cell transplants after high-dose chemotherapy in non-Hodgkin lymphoma (NHL) patients with central nervous system (CNS) involvement. This study reported durable remission and good disease control for NHL with CNS involvement. 

Many forms of NHL are treatable. When the CNS (brain and spinal cord) is involved, NHL is more difficult to treat. CNS involvement is typically defined by the presence of neurological symptoms or an increased white blood cell count in the cerebrospinal fluid. High-dose chemotherapy is often necessary. Healthy stem cells (immature cells) must be reintroduced (transplanted) following treatment. An autologous stem cell transplantation (auto-SCT; stem cells harvested from the patient) is considered the most effective therapy for high-risk NHL patients who have achieved complete remission after treatment. It is not clear if this is as effective in patients with CNS involvement. 

This study analyzed the records of 20 NHL patients with CNS involvement at diagnosis. 85% of these patients had diffuse large B-cell lymphoma. Patients were treated with high-dose chemotherapy involving thiotepa (Tepadina), busulfan (Myleran), and cyclophosphamide (Cytoxan). Patients then underwent auto-SCT while in complete remission (no sign of active disease). The average time from diagnosis to auto-SCT was 7 months. Patients were followed for an average of 4.4 years.

84% of patients were progression-free at 1 year. At 4 years, it was 77%. The estimated overall survival rate (proportion who have not died from any cause since treatment) was 82% at 4 years.

Three patients experienced a disease relapse during the study period. One patients died of progressive disease. Two patients went on to receive an allogeneic stem cell transplant (stem cells from a donor).

Low neutrophil levels (a type of white blood cells) with fever occurred in 80% of patients. Three patients experienced an infection. Five patients noted neurological side effects such as weakness and pain in arms and legs and problems concentrating. No late side effects were observed.

Authors concluded that auto-SCT after high-dose chemotherapy shows very good disease control in NHL patients with CNS involvement. 

Larger studies are needed to confirm these results.