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The influence of rituximab, high-dose therapy followed by autologous stem cell transplantation, and age in patients with primary CNS lymphoma

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Abstract

For patients with diffuse large B cell lymphoma without the involvement of the CNS, the addition of rituximab to standard chemotherapy has significantly improved survival. In this single-center, retrospective analysis, a total of 81 primary CNS lymphoma (PCNSL) patients treated in our institution between 2000 and 2011 were included. Beside first-line chemotherapy with or without rituximab, we evaluated the impact of age (≤/>60 years), autologous stem cell transplantation (ASCT +/−), and other factors upon overall survival (OS) and progression-free survival (PFS). In patients treated with rituximab (n = 27), 3-year OS was 77.8 % (95 % confidence interval (CI) 62–93 %). In contrast, in patients treated without rituximab (n = 52), 3-year OS was only 39.9 % (CI 27–53 %, Fig. 1). The difference in OS was significant in the univariate (p = 0.002) as well as in the multivariate analysis (p = 0.049, hazard ratio (HR) = 0.248). Patients ≤60 years of age (n = 28) had a 3-year OS of 78.2 % (CI 63–94 %); in patients >60 years (n = 51), 3-year OS was 38.7 % (CI 25–52 %). Patients who received high-dose therapy and ASCT had a 3-year OS of 85.2 % (CI 72–99 %), and 65.1 % were alive up to the time of analysis (range 9–131 months). Without ASCT, median OS was only 16 months (CI 11–21) and 3-year OS was 35.2 % (CI 22–48 %). Age and ASCT were significantly associated with better OS in univariate (p = 0.002 and p < 0.001) as well in multivariate analysis (p = 0.004, HR = 0.023 and p = 0.001, HR = 0.014). Rituximab treatment, ASCT, and age are independent prognostic factors for OS in the first-line treatment of PCNSL.

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Conflict of interest

Patrick Wuchter received honorarium for lectures from Sanofi and consulting fee or honorarium from ETICHO. Isabelle Krämer received research support from Gilead Sciences GmbH, Germany and honorarium for lectures from MSD SHARP & DOHME GmbH, Germany. All remaining authors have declared no conflicts of interest.

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    Authors and Affiliations

    1. Department of Hematology and Oncology, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

      M. Madle, I. Krämer, N. Lehners, M. Schwarzbich, P. Wuchter, G. Egerer, A.D. Ho & M. Witzens-Harig

    2. Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

      K. Herfarth

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    1. M. Madle
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    Correspondence to I. Krämer.

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    M. Madle and I. Krämer contributed equally to this work.

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    Madle, M., Krämer, I., Lehners, N. et al. The influence of rituximab, high-dose therapy followed by autologous stem cell transplantation, and age in patients with primary CNS lymphoma. Ann Hematol 94, 1853–1857 (2015). https://doi.org/10.1007/s00277-015-2470-4

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    • DOI: https://doi.org/10.1007/s00277-015-2470-4

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