Salvage treatment with etoposide (VP-16), ifosfamide and cytarabine (Ara-C) for patients with recurrent primary central nervous system lymphoma
Salvage treatment with etoposide (VP-16), ifosfamide and cytarabine (Ara-C) for patients with recurrent primary central nervous system lymphoma
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DOI：
10.1034/j.1600-0609.2003.00045.x
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发表时间：
2003-04-01
影响因子：
3.1
通讯作者：
Graus, F
中科院分区：
文献类型：
--
作者：
Arellano-Rodrigo, E;López-Guillermo, A;Graus, F
背景：以甲氨蝶呤为基础的联合方案和放射治疗(RT)改善了原发性中枢神经系统淋巴瘤(PCNSL)患者的生存率。然而，初治失败或复发的患者预后较差。关于复发的抢救治疗的数据很少。患者和方法：16例免疫功能正常的难治性(1例)或复发性(15例)PCNSL患者(男13例，女3例，中位年龄54岁)，确诊时采用环磷酰胺、阿霉素、Vimcritime、地塞米松/卡门泰、Uimcritime、阿糖胞苷和甲氨蝶呤(CHOD/BVAM)“Q3”方案和RT方案，接受依托泊苷(VP-16)、异环磷酰胺和阿糖胞苷(Ara-C)(VIA)化疗。方案包括依托泊苷100 mg/m(2)/d，第1~3天，异环磷酰胺1000 mg/m(2)/d，第1~5天，阿糖胞苷2000 mg/m(2)/12h，第1天。结果：首次完全缓解(CR)至复发的中位时间为19个月(6~46个月)。13名患者(81%)的功能状态小于或等于2，6名患者患有多灶性PCNSL，6名患者脑脊液细胞学检查阳性(8名患者中)。平均每个患者的疗程数为4个(范围：1-6个)。5名患者通过治疗完成了整个过程。6例患者(37%)获得完全缓解。存活患者平均随访15个月后，有2例复发，中位无失败生存期为5个月。已有12名患者死于PCNSL的进展，12个月的总存活率为41%[95%可信区间：16-66]。主要不良反应为世界卫生组织2-4级中性粒细胞减少症(69%)和血小板减少症(50%)。5例出现3~4级感染并发症。最后，一名患者出现了严重但可逆的异环磷酰胺脑病。结论：VIA方案是治疗复发性PCNSL的有效抢救方案。
Background: Survival of patients with primary central nervous system lymphoma (PCNSL) has improved with methotrexate-based combination regimens and radiotherapy (RT). However, the prognosis of patients who fail or relapse after initial response is poor. Very little data is available on salvage treatment at recurrence. Patients and methods: Sixteen immunocompetent patients (13 males/three females, median age 54 yr) with refractory (one patient) or recurrent (15 patients) PCNSL, homogeneously treated at diagnosis with the cyclophorphamide, doxorubicin, Vimcritime, dexamethasome/carmuntime, Uimcritime, cytarabine and methotrexate (CHOD/BVAM) "q3" and RT regimen, received etoposide (VP-16), ifosfamide and cytarabine (Ara-C) (VIA) chemotherapy as a salvage treatment. VIA included etoposide 100 mg/m(2)/d days 1-3, ifosfamide 1000 mg/m(2)/d days 1-5, and cytarabine 2000 mg/m(2)/12 h day 1. The therapy was repeated every 28 d for a total of planned six cycles. Results: Median time between first complete response (CR) and relapse was 19 months (range: 6-46 months). Thirteen patients (81%) had a performance status less than or equal to2, six had multifocal PCNSL and six (of eight tested) positive cerebrospinal fluid cytology. The median number of courses per patient was four (range: 1-6). Five patients completed the whole VIA therapy. Six patients (37%) achieved CR. After a median follow-up of 15 months for surviving patients, two have relapsed, with a median failure-free survival of 5 months. Twelve patients have died from progression of PCNSL, with a 12-month overall survival of 41% [95% confidence interval (CI): 16-66]. The major toxicity was World Health Organization grade 2-4 neutropenia (69% of patients) and thrombocytopenia (50%). Five patients had grade 3-4 infectious complications. Finally, one patient developed a severe but reversible ifosfamide encephalopathy. Conclusion: The data presented show that the chemotherapy VIA is an effective salvage regimen for patients with recurrent PCNSL.