The Addition of Temozolomide to Conditioning for Autologous Transplantation in Relapsed & Refractory Central Nervous System (CNS) Lymphoma (DRBEAT)

Inclusion Criteria:

• Patients ≥ 18 years of age and ≤ 75 years of age
• A mature B-cell lymphoma originating in the CNS, (WHO criteria)
• Patients with relapsed or progressed disease following therapy for CNS B Cell lymphoma who has achieved a subsequent CR or PR following salvage chemotherapy
• Patients who are initially refractory to therapy for CNS B cell lymphoma but who have achieved a CR or PR following a salvage chemotherapy regimen
• Patients who have developed CNS B cell CNS lymphoma in the setting of systemic disease as well. Provided there is limited systemic disease, such patients would be eligible
• Patients fit for autologous stem cell transplantation
• Patients able to understand and willing to sign a written informed consent document

Exclusion Criteria:

• Patients with CNS B-cell lymphoma in remission status post primary, initial therapy
• Patients initially enrolled at relapse but who were not responsive to induction therapy will not be continued on the study
• Patients whose life expectancy is severely limited by diseases other than malignancy
• Karnofsky Performance Score <60
• Patients who are pregnant or breastfeeding
• Patients who are HIV seropositive
• Patients who have an uncontrolled infection (presumed or documented) with progression after appropriate therapy for greater than one month
• Patients with symptomatic coronary artery disease, uncontrolled congestive heart failure. Left Ventricular Ejection Fraction is not required to be measured, however if it is measured, patient is excluded if ejection fraction is <30%
• Patients requiring supplementary continuous oxygen. DLCO is not required to be measured, however if it is measured, patient is excluded if DLCO <35%

• Patients with clinical or laboratory evidence of liver disease will be evaluated for the cause of liver disease, its clinical severity in terms of liver function and histology, and for the degree of portal hypertension. Patients with any of the following liver function abnormalities will be excluded

  1. Fulminant liver failure
  2. Cirrhosis with evidence of portal hypertension or bridging fibrosis
  3. Alcoholic hepatitis
  4. Esophageal varices
  5. A history of bleeding esophageal varices
  6. Hepatic encephalopathy
  7. Uncorrectable hepatic synthetic dysfunction evidenced by prolongation of the prothrombin time
  8. Ascites related to portal hypertension
  9. Chronic viral hepatitis with total serum bilirubin >3 mg/dL ____mg/dL
  10. Symptomatic biliary disease
• Patients with non-B-cell lymphomas or brain tumors that are not lymphomas are Excluded from the study. Non-B-cell lymphomas include: any T-cell lymphoma, NK-cell lymphomas, and Hodgkin lymphomas
• Patients for whom an insufficient number of stem cells (<2 X 106/kg) have been collected