Radiotherapy or Autologous Stem-Cell Transplantation for Primary CNS Lymphoma in Patients Age 60 Years and Younger: Long-Term Results of the Randomized Phase II PRECIS Study

被引：76

作者：

Houillier, Caroline ^{[1
]}

Dureau, Sylvain ^{[2
]}

Taillandier, Luc ^{[3
]}

Houot, Roch ^{[4
]}

Chinot, Olivier ^{[5
]}

Molucon-Chabrot, Cecile ^{[6
]}

Schmitt, Anna ^{[7
]}

Gressin, Remy ^{[8
]}

Choquet, Sylvain ^{[9
]}

Damaj, Gandhi ^{[10
,11
]}

Peyrade, Frederic ^{[12
]}

Abraham, Julie ^{[13
]}

Delwail, Vincent ^{[14
]}

Gyan, Emmanuel ^{[15
]}

Sanhes, Laurence ^{[16
]}

Cornillon, Jerome ^{[17
,18
]}

Garidi, Reda ^{[19
]}

Delmer, Alain ^{[20
]}

Al Jijakli, Ahmad ^{[21
]}

Morel, Pierre ^{[10
,22
]}

Waultier, Agathe ^{[23
]}

Paillassa, Jerome ^{[24
]}

Chauchet, Adrien ^{[25
]}

Gastinne, Thomas ^{[26
]}

Laadhari, Mouna ^{[27
]}

Plissonnier, Anne-Sophie ^{[28
]}

Feuvret, Loic ^{[29
]}

Cassoux, Nathalie ^{[30
,31
,32
]}

Touitou, Valerie ^{[33
]}

Ricard, Damien ^{[34
]}

Hoang-Xuan, Khe ^{[1
]}

Soussain, Carole ^{[35
,36
]}

机构：

[1] Sorbonne Univ, Grp Hosp Pitie Salpetriere, AP HP, IHU,ICM,Serv Neurol Mazarin, Paris, France

[2] Inst Curie, Unite Biometrie, St Cloud, France

[3] Serv Neurol, CHU Nancy, Nancy, France

[4] Univ Rennes 1, Serv Hematol, CHU Rennes, INSERM,U1236, Rennes, France

[5] Aix Marseille Univ, AP HM, CNRS, INP,Serv Neurooncol,CHU Timone, Marseille, France

[6] CHU Clermont Ferrand, Serv Hematol, Clermont Ferrand, France

[7] Inst Bergonie, Serv Hematol, Bordeaux, France

[8] CHU Grenoble, Oncohaematol Dept, Grenoble, France

[9] Grp Hosp Pitie Salpetriere, AP HP, Serv Hematol Clin, Paris, France

[10] CHU Amiens, Serv Hematol, Amiens, France

[11] Univ Hosp, Inst Hematol, Normandy, Caen, France

[12] Ctr Antoine Lacassagne, Serv Hematol, Nice, France

[13] CHU Limoges, Serv Hematol & Therapie Cellulaire, Limoges, France

[14] Univ Poitiers, Ctr Invest Clin, Serv Oncol Hematol & Therapie Cellulaire, CHU Poitiers,INSERM,CIC 1402, Poitiers, France

[15] CHU Tours, Serv Hematol & Therapie Cellulaire, Ctr Invest Clin, INSERM,U1517, Tours, France

[16] Ctr Hosp Perpignan, Serv Hematol, Tours, France

[17] Inst Cancerol Lucien Neuwirth, Serv Hematol, St Priest En Jarez, France

[18] CHU St Etienne, Dept Hematol Clin, St Etienne, France

[19] Ctr Hosp St Quentin, Serv Hematol, St Etienne, France

[20] CHU Reims, Serv Hematol, Reims, France

[21] Ctr Hosp Argenteuil, Serv Hematol, Argenteuil, France

[22] Ctr Hosp Lens, Serv Hematol, Lens, France

[23] CHU Nimes, Serv Hematol, Nimes, France

[24] CHU Angers, Serv Hematol, Angers, France

[25] CHU Besancon, Serv Hematol, Besancon, France

[26] CHU Nantes, Serv Hematol, Nantes, France

[27] Inst Curie, Dept Imagerie Med, Site St Cloud, Paris, France

[28] Inst Curie, DREH Pole Promot, St Cloud, France

[29] Grp Hosp Pitie Salpetriere, AP HP, Serv Radiotherapie, Paris, France

[30] Inst Curie, Serv Ophtalmol, Site Paris, Paris, France

[31] Univ Paris 05, Paris, France

[32] PSL Paris Sci & Lettre, Paris, France

[33] Grp Hosp Pitie Salpetriere, AP HP, Serv Ophtalmol, Paris, France

[34] Hop Instruct Armees Percy, Serv Sante Armees, Ecole Val Grace, Serv Neurol, Clamart, France

[35] PSL Res Univ, Serv Hematol, Inst Curie, Site St Cloud, Paris, France

[36] PSL Res Univ, INSERM, U932, Inst Curie, Paris, France

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2022年 / 40卷 / 32期

关键词：

NERVOUS-SYSTEM LYMPHOMA; CYCLOPHOSPHAMIDE; BUSULFAN; THIOTEPA;

D O I：

10.1200/JCO.22.00491

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We previously reported the results of a randomized phase II study in patients with newly diagnosed primary CNS lymphoma (age 18-60 years). Patients were treated with high-dose methotrexate-based induction chemotherapy followed by whole-brain radiotherapy (WBRT) or high-dose chemotherapy (thiotepa-busulfan-cyclophosphamide) with autologous stem-cell transplantation (ASCT). The median follow-up was 33 months. In this report, we provide long-term data (median follow-up, 8 years) regarding the outcomes and toxicities. Fifty-three and 44 patients received induction chemotherapy followed by WBRT or ASCT, respectively. Their 8-year event-free survival from random assignment was 67% and 39% in the ASCT and WBRT arms, respectively (P = .03), with a significantly lower risk of relapse after ASCT (hazard ratio, 0.13; P < .001). One third of patients who relapsed after WBRT were alive after salvage treatment. Five and four patients died of ASCT and WBRT-related toxicities, respectively. The 8-year overall survival was 69% and 65% in the ASCT and WBRT arms, respectively (not significant). Balance (52% v 10%, P <= 0.001) and neurocognition (64% v 13%, P < .001) significantly deteriorated after WBRT compared with ASCT during the follow-up. This study shows that 40 Gy WBRT should be avoided in first-line treatment because of its neurotoxicity and suboptimal efficacy in reducing relapses while ASCT appears to be highly efficient in preventing relapses.

引用

页码：3692 / +

页数：13

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