As reported in the Journal of Clinical Oncology by Houillier et al, 8-year follow-up in the French phase II PRECIS trial has shown a maintained event-free survival benefit with autologous stem cell transplantation (ASCT) vs whole-brain radiotherapy (WBRT) as consolidation in patients aged ≤ 60 years with newly diagnosed primary central nervous system (CNS) lymphoma. Risk of relapse was significantly reduced with ASCT; no difference in overall survival was observed.
Study Details
In the multicenter study, 140 patients were randomly assigned between 2008 and 2014 to consolidation with WBRT (40 Gy) or high-dose chemotherapy (thiotepa/busulfan/cyclophosphamide) followed by ASCT after high-dose methotrexate-based induction chemotherapy. A total of 97 patients completed induction, with 53 patients in the WBRT group and 44 in the ASCT group entering the consolidation phase. In the initial report, at a median follow-up of 33 months, 2-year event-free survival from consolidation was 87% in the ASCT group vs 69% in the WBRT group (P = .03).
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.— Houillier et al
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Key Findings
In the current report, median follow-up was 98 months. Event-free survival at 8 years after random assignment was 67% (95% confidence interval [CI] = 55%–83%) in the ASCT group vs 39% (95% CI = 27%–57%) in the WBRT group (P = .03).
Relapse occurred in 3 patients in the ASCT group vs 24 in the WBRT group (hazard ratio = 0.13, P < .001). Among patients with relapse after WBRT, 8 remained alive and disease-free after salvage treatment at last follow-up, including 7 of 13 patients who received ASCT at relapse.
Overall survival at 8 years after random assignment was 69% (95% CI = 57%–85%) in the ASCT group vs 65% (95% CI = 52%–81%) in the WBRT group (P = .90). A total of five patients died from ASCT-related toxicity, and four died from WBRT-related toxicity. Compared with the ASCT group, more patients in the WBRT group had significant deteriorations in balance (52% vs 10%, P = .001) and neurocognition (64% vs 13%, P < .001) during follow-up.
The investigators concluded, “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.”
Carole Soussain, MD, PhD, of Institut Curie, Site Saint-Cloud, Saint-Cloud, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The trial was an investigator-initiated study primarily funded by a French government grant. Roche, Amgen, and Pierre Fabre provided additional financial support. For full disclosures of the study authors, visit ascopubs.org.
