Korean J Hematol.  2005 Sep;40(3):172-176. 10.5045/kjh.2005.40.3.172.

Three Cases Treated with High-dose Cytarabine and Etoposide followed by Autologous Stem Cell Transplantation for Relapsed Primary CNS Lymphoma

• Koo JE
• Ryu MH
• Shon HJ
• Kang HJ
• Kim WK
• Suh C
• Lee JS
• Kang YK

• KMID: 1610811
• DOI: http://doi.org/10.5045/kjh.2005.40.3.172

Abstract

The treatment outcomes with conventional second-line chemotherapy or radiotherapy aregenerally very poor for patients with relapsed primary CNS lymphoma (PCNSL). We treated three relapsed PCNSL patients with high-dose cytarabine plus etoposide (CYVE) chemotherapy, and this was followed by autologous stem cell transplantation (ASCT). The salvage CYVE chemotherapy consisted of cytarabine 2g/m2/d on days 2 to 5 in a 3-hour infusion and 50mg/m2/d on days 1 to 5 in a 12-hourinfusion, and etoposide 200mg/m2/d on days 2 to 5 in a 2-hour infusion. After two cycles of CYVE chemotherapy, two patients achieved a complete response (CR), and one patient achieved a partial response (PR). All three patients experienced febrile neutropenia and grade 4 thrombocytopenia with the CYVE chemotherapy. However, the hematologic toxicities were well managed without any complications. The conditioning regimen for ASCT consisted of BCNU 300mg/m2 on day -7, etoposide 100mg/m2 on days -6 to -3, cytarabine 100mg/m2 on days -6 to -3, and cyclophosphamide 35mg/kg on days -6 to -3 (BEAC). After ASCT, the patient who initially showed a PR with CYVE chemotherapy then achieved a CR. At the time of this report, one patient remained alive in CR for 41 months after CYVE chemotherapy. The remaining two patients experienced relapse 5 months and 4 months after ASCT, respectively, and they ultimately died of disease progression 18 months and 8 months after ASCT, respectively. In our cases, the CYVE chemotherapy+ASCT was well tolerated, and this induced the complete disappearance of the tumor, and one patient showed prolonged disease-free survival. CYVE chemotherapy+ASCT could be a treatment option for relapsed PCNSL.

Keyword

Autoimmune hemolytic anemia; Waldenstrom macroglobulinemia; Fludarabine

MeSH Terms

Anemia, Hemolytic, Autoimmune
Carmustine
Cyclophosphamide
Cytarabine*
Disease Progression
Disease-Free Survival
Drug Therapy
Etoposide*
Febrile Neutropenia
Humans
Lymphoma*
Radiotherapy
Recurrence
Stem Cell Transplantation*
Stem Cells*
Thrombocytopenia
Waldenstrom Macroglobulinemia
Carmustine
Cyclophosphamide
Cytarabine
Etoposide

Figure

• 

  Fig. 1. PCNSL of left temporal lobe demonstrated on T2 weighted magnetic resonance image at diagnosis.

• 

  Fig. 2. Disappeared PCNSL on T2 weighted magnetic resonance image after ASCT.

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