High-dose chemotherapy with autologous haematopoietic stem cell transplantation in patients with isolated vitreoretinal lymphoma: a LOC network study - Report - MDSpire
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High-dose chemotherapy with autologous haematopoietic stem cell transplantation in patients with isolated vitreoretinal lymphoma: a LOC network study
High-Dose Chemotherapy and Autologous Stem Cell Transplant in Isolated Vitreoretinal Lymphoma
Overview
This retrospective analysis of 38 patients with isolated vitreoretinal lymphoma (VRL) treated with high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HCT-ASCT) demonstrates a high complete response rate (87%) and promising survival outcomes. The study highlights the feasibility and potential efficacy of HCT-ASCT as a consolidation therapy in this rare and challenging lymphoma subtype.
Background
Vitreoretinal lymphoma (VRL) is a rare lymphoma, predominantly diffuse large B-cell type, often presenting as isolated ocular disease or associated with central nervous system lymphoma (CNSL). VRL typically progresses indolently but carries a high risk of CNS relapse, which worsens prognosis. Treatment strategies vary widely due to the rarity of VRL and lack of prospective studies, with systemic high-dose methotrexate commonly used by analogy to primary CNS lymphoma. High-dose chemotherapy followed by autologous stem cell transplantation (HCT-ASCT) has been proposed as consolidation therapy, but data on its efficacy and safety in isolated VRL remain limited.
Data Highlights
Parameter
Value
Number of patients
38
Median age at HCT-ASCT
61 years (range 42–73)
Gender
22 females, 16 males
Initial diagnosis
53% primary VRL, 47% PCNSL (including 18% with ocular involvement)
Line of treatment for HCT-ASCT
8% first line, 63% second line, 29% subsequent lines
Among 38 patients with isolated VRL treated with HCT-ASCT, 87% achieved complete response post-transplant.
Median age at transplantation was 61 years, with most patients receiving HCT-ASCT as second-line therapy.
Thiotepa-based conditioning regimens were used in 84% of patients, reflecting current practice preferences.
Pre-transplant response status was favorable, with 76% in complete response and 18% in partial response.
Elevated IL-10 levels in aqueous humour persisted in some patients despite clinical response, indicating potential subclinical disease activity.
HCT-ASCT was feasible and generally well tolerated in this patient population.
Clinical Implications
HCT-ASCT represents a promising consolidation strategy for isolated VRL, achieving high complete response rates even in relapsed settings. Given the risk of CNS progression in VRL, aggressive systemic therapy including thiotepa-based conditioning may improve long-term outcomes. Multidisciplinary management and careful patient selection are essential to optimize treatment benefits and monitor for residual disease.
Conclusion
This national retrospective study supports the efficacy and safety of high-dose chemotherapy followed by autologous stem cell transplantation in isolated vitreoretinal lymphoma. Further prospective studies are warranted to confirm these findings and refine treatment protocols.
References
LOC Network Analysis 2023 -- Administration of High-Dose Chemotherapy Followed by Autologous Hematopoietic Stem Cell Transplantation for Isolated Vitreoretinal Lymphoma
