Patient Reported and Clinical Outcomes after High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Primary Central Nervous System Lymphoma

Simple Summary Primary central nervous system lymphomas are rare, but the incidence in the elderly population increases constantly. Consequently, more and more elderly patients are treated with high-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT). However, data on the recovery after this demanding therapy are scarce, especially concerning quality of life (QoL)-focused patient-reported outcome parameters. Seeing even better QoL results in the elderly compared to the younger population after HDC/ASCT this single-center analysis challenges the assumption of an insufficient recovery by seeing even better QoL results in the elderly compared to the younger population after HDC/ASCT. Moreover, no significant age-dependent differences were observed regarding overall and progression free survival as well as ECOG performance status and mini-mental state examination. Together, our data indicate that HDC/ASCT is an effective therapy with respect to disease control and global health status. Primary central nervous system lymphomas (PCNSL) are rare and associated with an adverse prognosis. High-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT) improves progression free (PFS) and overall survival (OS) but neurocognition, performance status and quality of life (QoL) in patient-reported outcome (PRO) after HDC/ASCT remains underexplored. Especially elderly patients may insufficiently recover from this demanding therapy. Therefore, this single-center analysis investigated all PCNSL patients who received HDC/ASCT at the University Hospital Tubingen from 2006-2021 (n = 40, median age 60.5 years) in a retrospective manner. The 2-year PFS/OS was 78.7%/77.3%, respectively, without significant differences between the tested age-groups (<= 60 vs. >60 years, p = 0.531/p = 0.334). Higher Thiotepa dosage was an independent predictor for better OS (p = 0.018). Additionally, a one-time prospective, cross-sectional analysis after HDC/ASCT in the same cohort was performed (n = 31; median follow-up 45 months). Here, the median ECOG improved by HDC/ASCT from 1 to 0 and mini-mental state examinations revealed unimpaired neurocognitive functioning (median 28 pts.). PRO data collected by EORTC QLQ-C30 showed a good QoL in both age groups with an average global health status (GHS) of 68.82% (<= 60y: 64.72%, >60y: 74.14%). Together, our data indicate that HDC/ASCT is an effective therapy with respect to disease control, overall health status and quality of life, irrespective of patient age.