High-dose Chemotherapy and Stem Cell Transplantation for Central Nervous System (CNS) Relapse of Aggressive Lymphomas

Combined Systemic and Intrathecal Chemotherapy Followed by High-dose Chemotherapy and Autologous Stem Cell Transplantation for CNS Relapse of Aggressive Lymphomas

Central nervous system (CNS) relapses of aggressive lymphomas are a rare but devastating complication. There is no therapy standard, conventional approaches are palliative. This study investigates an intensive chemotherapy with CNS penetrating drugs followed by high-dose chemotherapy and autologous stem cell transplantation as a potentially curative approach.

Inclusion Criteria:

• highly-malignant non-Hodgkins-Lymphoma, mantle-cell lymphoma or follicular lymphoma 3°
• CNS relapse (meningeal or/and intraparenchymal) with or without systemic lymphoma manifestations
• ECOG performance score ≤2
• no active infection
• negative HIV-serology
• adequate renal function (creatinine clearance > 50 ml/min)
• adequate bone marrow function (granulocytes >1500/μl, platelets > 80000/μl)
• normal bilirubin, AST < 3 x UNL
• negative pregnancy test

Exclusion Criteria:

• newly diagnosed NHL with primary CNS involvement
• indolent NHL, lymphoblastic NHL or Burkitt lymphoma
• preceding CNS irradiation
• pretreatment of CNS relapse other than corticosteroids
• immunosuppression, concomitant immunosuppressive therapy, status after organ transplantation or allogenous stem cell transplantation
• second cancer other than basalioma or cervical carcinoma in situ within the last 5 years
• unfit to receive an intensive chemotherapy
• pregnancy or breastfeeding
• known intolerance to MTX, ifosfamide, Depocyte, cytarabine, thiotepa, carmustine or etoposide