PURPOSE: To determine the impact of prior or current CNS disease on the outcome of high-dose chemotherapy for patients with hematologic malignancies. PATIENTS AND METHODS: In a 54-month period, 373 patients with hematologic malignancies underwent allogeneic or autologous bone marrow transplantation (BMT) or blood stem-cell transplantation using high-dose thiotepa, busulfan, and cyclophosphamide (TBC) as the preparative regimen. Four patients with active CNS disease at BMT and 20 patients with a history of prior CNS disease were identified. The outcomes of those with a history of CNS disease were compared with those of a matched control group. RESULTS: Of four patients with active CNS disease at the time of BMT, two had CNS recurrences and one recurred in the bone 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 the DFS rate for the control group 39% +/- 24% (P = .053). An increased rate of treatment-related toxicity and especially grades II to IV CNS toxicity accounted for the poorer outcome of patients who had a history of CNS disease. Recurrence rates were not significantly different between the two groups. Prior radiation to the CNS correlated with CNS complications posttransplant (p = .01). CONCLUSION: Consolidation with TBC and BMT can induce prolonged DFS in a proportion of patients with a history of CNS disease. Such patients are at increased risk for CNS complications that lead to an inferior overall outcome when compared with a control group.
PURPOSE: To determine the impact of prior or current CNS disease on the outcome of high-dose chemotherapy for patients with hematologic malignancies. PATIENTS AND METHODS: In a 54-month period, 373 patients with hematologic malignancies underwent allogeneic or autologous bone marrow transplantation (BMT) or blood stem-cell transplantation using high-dose thiotepa, busulfan, and cyclophosphamide (TBC) as the preparative regimen. Four patients with active CNS disease at BMT and 20 patients with a history of prior CNS disease were identified. The outcomes of those with a history of CNS disease were compared with those of a matched control group. RESULTS: Of four patients with active CNS disease at the time of BMT, two had CNS recurrences and one recurred in the bone 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 the DFS rate for the control group 39% +/- 24% (P = .053). An increased rate of treatment-related toxicity and especially grades II to IV CNS toxicity accounted for the poorer outcome of patients who had a history of CNS disease. Recurrence rates were not significantly different between the two groups. Prior radiation to the CNS correlated with CNS complications posttransplant (p = .01). CONCLUSION: Consolidation with TBC and BMT can induce prolonged DFS in a proportion of patients with a history of CNS disease. Such patients are at increased risk for CNS complications that lead to an inferior overall outcome when compared with a control group.
Authors: Jacoline E Bromberg; Jeanette K Doorduijn; Gerald Illerhaus; Kristoph Jahnke; Agniezka Korfel; Lars Fischer; Kristina Fritsch; Outti Kuittinen; Samar Issa; Cees van Montfort; Martin J van den Bent Journal: Haematologica Date: 2012-11-09 Impact factor: 9.941
Authors: Richard T Maziarz; Zhiwei Wang; Mei-Jie Zhang; Brian J Bolwell; Andy I Chen; Timothy S Fenske; Cesar O Freytes; Robert P Gale; John Gibson; Brandon M Hayes-Lattin; Leona Holmberg; David J Inwards; Luis M Isola; Hanna J Khoury; Victor A Lewis; Dipnarine Maharaj; Reinhold Munker; Gordon L Phillips; David A Rizzieri; Philip A Rowlings; Wael Saber; Prakash Satwani; Edmund K Waller; David G Maloney; Silvia Montoto; Ginna G Laport; Julie M Vose; Hillard M Lazarus; Parameswaran N Hari Journal: Br J Haematol Date: 2013-07-06 Impact factor: 6.998
Authors: Basem M William; Tao Wang; Michael D Haagenson; Katharina Fleischhauer; Michael Verneris; Katharine C Hsu; Marcos J de Lima; Marcelo Fernandez-Viña; Stephen R Spellman; Stephanie J Lee; Brian T Hill Journal: Biol Blood Marrow Transplant Date: 2017-11-16 Impact factor: 5.742
Authors: Yi-Bin Chen; Tracy Batchelor; Shuli Li; Ephraim Hochberg; Mark Brezina; Sooae Jones; Candice Del Rio; Morgan Curtis; Karen K Ballen; Jeffrey Barnes; Andrew S Chi; Jorg Dietrich; Jessica Driscoll; Elizabeth R Gertsner; Fred Hochberg; Ann S LaCasce; Steven L McAfee; Thomas R Spitzer; Lakshmi Nayak; Philippe Armand Journal: Cancer Date: 2014-09-09 Impact factor: 6.860
Authors: Patricia A Young; Daria Gaut; Davis K Kimaiyo; Jonathan Grotts; Tahmineh Romero; John Chute; Gary Schiller; Sven de Vos; Herbert A Eradat; John Timmerman Journal: Clin Lymphoma Myeloma Leuk Date: 2020-02-20