Autologous haematopoietic cell transplantation for non‐Hodgkin lymphoma with secondary CNS involvement

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

Pre-existing central nervous system (CNS) involvement may influence referral for autologous haematopoietic cell transplantation (AHCT) for patients with non-Hodgkin lymphoma (NHL). The outcomes of 151 adult patients with NHL with prior secondary CNS involvement (CNS(+) ) receiving an AHCT were compared to 4688 patients without prior CNS lymphoma (CNS(-) ). There were significant baseline differences between the cohorts. CNS(+) patients were more likely to be younger, have lower performance scores, higher age-adjusted international prognostic index scores, more advanced disease stage at diagnosis, more aggressive histology, more sites of extranodal disease, and a shorter interval between diagnosis and AHCT. However, no statistically significant differences were identified between the two groups by analysis of progression-free survival (PFS) and overall survival (OS) at 5 years. A matched pair comparison of the CNS(+) group with a subset of CNS(-) patients matched on propensity score also showed no differences in outcomes. Patients with active CNS lymphoma at the time of AHCT (n = 55) had a higher relapse rate and diminished PFS and OS compared with patients whose CNS lymphoma was in remission (n = 96) at the time of AHCT. CNS(+) patients can achieve excellent long-term outcomes with AHCT. Active CNS lymphoma at transplant confers a worse prognosis.