Putting caution in TEAM: High-dose chemotherapy with autologous HSCT for primary central nervous system lymphoma

摘要

We read with great interest the recent manuscript on treatment of primary central nervous system lymphoma (PCNSL) with high-dose chemotherapy followed by autologous hematopoietic SCT. The authors highlight several important issues regarding the difficulties with treating this disease. Indeed, a recent review of clinical experience with PCNSL concluded that high-dose chemotherapy ± whole-brain radiotherapy followed by autologous HSCT holds promise to improve patient outcomes. Although this latest review of PCNSL is thought-provoking, we find discrepancies that may confound the authors' conclusions. As acknowledged by the authors, there is a great heterogeneity of both induction and conditioning regimens employed in studies for newly-diagnosed PCNSL. Bearing in mind not only the variations in chemotherapy regimens, but also the variations of survival seen in these studies, we are surprised to find the authors' conclusion of superiority with 'thiotepa/busulfan based conditioning' and recommendation of this strategy as a 'suggested treatment approach in patients with PCNSL'.