A nonradiation-containing, intermediate-dose methotrexate regimen for elderly patients with primary central nervous system lymphoma
A nonradiation-containing, intermediate-dose methotrexate regimen for elderly patients with primary central nervous system lymphoma
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DOI：
10.1007/s12185-010-0703-9
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发表时间：
2010-11-01
影响因子：
2.1
通讯作者：
Chiba, Shigeru
中科院分区：
文献类型：
--
作者：
Taoka, Kennichi;Okoshi, Yasushi;Chiba, Shigeru
为了评价含中剂量甲氨蝶呤(MTX)化疗而非全脑放射治疗老年原发性中枢神经系统淋巴瘤(PCNSL)的疗效、急性毒性和迟发性神经毒性，我们对2005年1月至2009年12月在筑波大学医院接受单独化疗的老年初诊PCNSL患者(N=17；中位年龄67岁)进行了回顾性分析。诱导治疗包括静脉注射中剂量甲氨蝶呤(1g/m(2))、雷尼莫司汀、丙卡巴肼、甲基强的松龙、鞘内注射甲氨蝶呤和阿糖胞苷。完全缓解(CR)或部分缓解(PR)的患者每6周接受5个周期的维持治疗。本研究中所有患者均达到CR或PR，并接受维持治疗。总生存率(OS)和无进展生存率(PFS)1年分别为100%和80%，2年分别为61%和43%。中位OS为36个月，PFS为20个月。在淋巴瘤进展之前，任何患者都没有出现迟发性神经毒性。在缓解率、OS和PFS方面，日本老年患者使用的非含放射、中等剂量的MTX方案与以前的包括更强化疗的方案相当。急性和延迟性毒性是可控的，生活质量一直保持到进展。
To assess the efficacy, acute toxicity, and delayed neurotoxicity of intermediate-dose methotrexate (MTX)-containing chemotherapy without whole-brain radiotherapy in the treatment of elderly patients with primary central nervous system lymphoma (PCNSL), we conducted a retrospective analysis of elderly patients (N = 17; median age 67) with newly diagnosed PCNSL who were treated with chemotherapy alone at Tsukuba University Hospital from January 2005 to December 2009. Induction therapy consisted of intravenous intermediate-dose MTX (1 g/m(2)), ranimustine, procarbazine, methylprednisolone, and intrathecal MTX and cytarabine. Patients who achieved complete response (CR) or partial response (PR) received 5 cycles of maintenance therapy every 6 weeks. All patients in this study achieved CR or PR and received maintenance therapy. Overall survival (OS) and progression-free survival (PFS) were 100 and 80% at 1 year, and 61 and 43% at 2 years, respectively. The median OS and PFS were 36 and 20 months, respectively. Delayed neurotoxicity did not develop in any patient before lymphoma progression. In terms of response rate, OS, and PFS, the nonradiation-containing, intermediate-dose MTX-containing protocol used in elderly Japanese patients was comparable to previous protocols that consisted of more intensive chemotherapy. Acute and delayed toxicities were manageable and quality of life was maintained until progression.