Blood：甲氨蝶呤可改善一种淋巴瘤复发
美国俄勒冈卫生和科技大学Doolittle等报告，对于累及脑实质的非霍奇金淋巴瘤(NHL)中枢神经系统(CNS)复发，甲氨蝶呤治疗有效。相关论文发表在《血液》杂志上。
研究者筛选了113例患者(中位年龄61岁)，其中83%患有弥漫性大B细胞淋巴瘤(DLBCL)。这些患者于1980-2004年经首次淋巴瘤治疗后已获得完全缓解，但随后又出现脑实质复发。88%的患者在首次发病时就有结外病变，大约三分之一患者有两处或两处以上部位受累。50%患者有国际预后指数(IPI)评分和血清乳酸脱氢酶(LDH)资料，其中约1/5患者IPI评分为4或5，约半数患者LDH水平升高。
在复发确诊后，78例患者接受化疗(71例以甲氨蝶呤为主)加或不加全脑放射治疗(WBRT)，其余患者仅接受WBRT。10例患者在大剂量化疗后接受了干细胞移植。中位进展时间为1年，中位总生存时间为1.6年，26例(23%)患者生存时间≥3年。多变量模型分析显示，复发时年龄小于60岁(P=0.006)、接受甲氨蝶呤一线治疗(P=0.008)与生存期较长显著相关。
该研究证实，诱导化疗后已获缓解但有一处以上结外部位受累、高IPI评分和LDH水平升高的患者，CNS复发危险较高，但对高危患者的最佳预防性措施和复发后最佳治疗方法仍待明确。大剂量甲氨蝶呤是治疗复发所必需的，一般来说应避免有迟发性神经毒性的WBRT。有必要寻找CNS复发的生物学标志物和更好的治疗方法，以进一步改善患者转归。（来源：中国医学论坛报）
生物谷推荐原始出处：
（Blood），Vol. 111, No. 3, pp. 1085-1093，Nancy D. Doolittle, Emanuele Zucca
Brain parenchyma involvement as isolated central nervous system relapse of systemic non-Hodgkin lymphoma: an International Primary CNS Lymphoma Collaborative Group report
1 Department of Neurology, Oregon Health and Science University, Portland; 2 Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY; 3 Division of Medical Oncology, British Columbia Cancer Agency and University of British Columbia, Vancouver; 4 Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel; 5 Department of Neuro-Oncology, Daniel den Hoed Cancer Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands; 6 Department of Neurosurgery, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland; 7 Department of Hematology, Centre Rene Huguenin, Saint Cloud, France; 8 Department of Hematology, Oncology, and Transfusion Medicine, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany; 9 Divisions of Hematology and Blood and Marrow Transplant, Mayo Clinic College of Medicine, Rochester, MN; 10 Department of Hematology and Oncology, University Medical Center, Freiburg, Germany; 11 University of Virginia Neuro-Oncology Center, Charlottesville; 12 Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston; 13 Cancer Research United Kingdom–Medical Oncology Unit, Barts and the London, London, United Kingdom; 14 Department of Pharmacy Practice, Oregon State University, Portland; and 15 Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
Isolated central nervous system (CNS) relapse involving the brain parenchyma is a rare complication of systemic non-Hodgkin lymphoma. We retrospectively analyzed patient characteristics, management, and outcomes of this complication. After complete response to initial non-Hodgkin lymphoma treatment, patients with isolated CNS relapse with the brain parenchyma as initial relapse site were eligible. Patients with isolated CNS relapse involving only the cerebrospinal fluid were not eligible. Information on 113 patients was assembled from 13 investigators; 94 (83%) had diffuse large B-cell lymphoma. Median time to brain relapse was 1.8 years (range, 0.25-15.9 years). Brain relapse was identified by neuroimaging in all patients; in 54 (48%), diagnostic brain tumor specimen was obtained. Median overall survival from date of brain relapse was 1.6 years (95% confidence interval, 0.9-2.6 years); 26 (23%) have survived 3 years or more. Median time to progression was 1.0 year (95% confidence interval, 0.7-1.7 years). Age less than 60 years (P = .006) at relapse and methotrexate use (P = .008) as front-line treatment for brain relapse were significantly associated with longer survival in a multivariate model. Our results suggest systemic methotrexate is the optimal treatment for isolated CNS relapse involving the brain parenchyma. Long-term survival is possible in some patients.
- 众说风云 (已有0条评论)
