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Age 60 or older is an independent predictor of outcomes after thiotepa-based autologous transplant in primary CNS lymphoma: a CIBMTR analysis

Bone Marrow Transplantation (2025)Cite this article

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To the Editor:

Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin lymphoma confined to the brain and central nervous system, with over half of cases occurring in patients aged >60 [1]. For eligible patients, the standard of care is high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) [1, 2]. Conditioning regimens incorporating thiotepa, such as thiotepa/busulfan/cyclophosphamide (TBC) or thiotepa/carmustine (BCNU/thiotepa), are favored for their central nervous system penetrance [3, 4]. However, the safety and efficacy of thiotepa-based regimens in older adults remains uncertain [5]. Prior analyses demonstrate an increased risk of non-relapse mortality (NRM) in patients over 60, though it is unclear whether this is driven by comorbidities or poor performance status [3]. For patients unfit for ASCT, treatment options are limited with lower curative potential [1]. In this context, there has been interest in anti-CD19 chimeric antigen receptor T-cell therapies, which penetrate the CNS and may offer an effective, better tolerated regimen in older patients [6, 7].

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Fig. 1: Survival and competing risk outcomes.

Data availability

The publicly dataset analyzed during the current study is available in the CIBMTR repository. The link to access the dataset is at https://cibmtr.org/Manuscript/a020h00001HH9E5AAL/P-5398.

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Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA

    Neela Easton, Joshua Fein, Peter Martin, Juliet Barker & Samuel Yamshon

  2. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA

    David G. Goldfarb

  3. Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar

    Ahmed El-Naas

  4. Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA

    Richard Kam

  5. Weill Cornell Medicine, Cornell University, New York, NY, USA

    Gwynne Ozkan

  6. Department of Pharmacy, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA

    Michelle Pasciolla

Authors
  1. Neela Easton
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  2. David G. Goldfarb
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  9. Juliet Barker
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  10. Samuel Yamshon
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Contributions

NE extracted and analyzed the data, interpreted the results, created figures and tables, and wrote the report. DGG performed a quality check on data analysis and result interpretation. AEN interpreted results and contributed to writing the report. RK contributed to writing the report. GO contributed to writing the report. MP, JF, PM, and JB provided feedback on the report. SY designed the study, interpreted the results, contributed to writing the report, and provided feedback on the report.

Corresponding author

Correspondence to Samuel Yamshon.

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Competing interests

Author SY: Advisory Board: Bristol Myers Squibb, Kite Pharma, Abbvie, Genmab; Consulting: Bristol Myers Squibb, Kite Pharma.

Ethics approval and consent to participate

All procedures were carried out in accordance with relevant institutional and federal ethical standards. Data for this analysis were obtained from the Center for International Blood and Marrow Transplant Research (CIBMTR), a research collaboration between the National Marrow Donor Program (NMDP) and the Medical College of Wisconsin. The CIBMTR is supported primarily by Public Health Service grant U24CA076518 from the National Cancer Institute, the National Heart, Lung, and Blood Institute, the National Institute of Allergy and Infectious Diseases, contract 75R60222C00011 from the Health Resources and Services Administration, and grants N00014-23-1-2057 and N00014-24-1-2057 from the Office of Naval Research. All CIBMTR studies are conducted in compliance with applicable federal regulations for the protection of human research participants. Written informed consent for data collection and research use was obtained from all participants. Institutional review boards of both the Medical College of Wisconsin and the National Marrow Donor Program approved the original CIBMTR study protocol.

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Easton, N., Goldfarb, D.G., El-Naas, A. et al. Age 60 or older is an independent predictor of outcomes after thiotepa-based autologous transplant in primary CNS lymphoma: a CIBMTR analysis. Bone Marrow Transplant (2025). https://doi.org/10.1038/s41409-025-02758-0

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