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. ABSTRACT: 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 Tübingen 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.