Prediction and prevention of central nervous system relapse in patients with extranodal natural killer/T-cell lymphoma
Prediction and prevention of central nervous system relapse in patients with extranodal natural killer/T-cell lymphoma
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DOI：
10.1182/blood.2020005026
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发表时间：
2020-11-26
期刊：
影响因子：
20.3
通讯作者：
Kim, Won Seog
中科院分区：
文献类型：
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作者：
Kim, Hyera;Jeong, Hyehyun;Kim, Won Seog
由于非蒽环类药物为主的L-门冬酰胺酶化疗改善了结外自然杀伤/T细胞淋巴瘤（ENKTL）患者的生存结局，因此与以往报道相比，中枢神经系统（CNS）复发的发生率可能有所不同。在这项研究中，我们试图确定中枢神经系统复发的发生率和预测因素，并评估用中等剂量甲氨蝶呤（ID-MTX）预防中枢神经系统复发的必要性。对接受非蒽环类药物化疗的399例ENKTL培训队列患者和253例ENKTL验证队列患者的记录进行了审查。根据化疗方案是否包括ID-MTX> 2 g/m2将患者分为2组。使用CNS复发的1点强预测因子（PINK;风险比[HR]，2.908; P = 0.030和结节受累[>= 2]; HR，4.161; P = 0.001）开发了一种新的中枢神经系统自然杀伤预后指数（CNS-PINK）模型，并计算为评分之和。CNS-PINK高危组定义为2分。CNS复发的累积发生率在训练（P <0.001）和验证（P = 0.038）队列中的CNS-PINK风险组之间是不同的。在高危CNS-PINK组中，接受SMILE或SMILE样方案联合ID-MTX（S-ID-MTX）治疗的患者CNS复发率低于接受其他方案不联合ID-MTX治疗的患者（P = 0.029）。CNS-PINK对ENKTL患者CNS复发具有较强的预测性。S-ID-MTX预防高危CNS-PINK患者CNS事件的有效性应在未来的研究中验证。
Because non-anthracycline-based chemotherapy with L-asparaginase has improved survival outcomes in patients with extranodal natural killer/T-cell lymphoma (ENKTL), the incidence of central nerve system (CNS) relapse can be different when compared with that in previous reports. In this research, we sought to identify the incidence of and predictors for CNS relapse and to evaluate the necessity of CNS prophylaxis with intermediate-dose methotrexate (ID-MTX). The records of 399 patients in the training cohort and 253 patients in the validation cohort with ENKTL who received non-anthracycline-based chemotherapy were reviewed. Patients were divided into 2 groups according to whether the chemotherapy regimen included ID-MTX above 2 g/m2. A new central nervous system-prognostic index of natural killer (CNS-PINK) model was developed using 1-point powerful predictors of CNS relapse (PINK; hazard ratio [HR], 2.908; P = .030 and extranodal involvement [>= 2]; HR, 4.161; P = .001) and was calculated as a sum of scores. The high-risk group of CNS-PINK was defined as 2 points. The cumulative incidence of CNS relapse was different between the CNS-PINK risk groups in the training (P < .001) and validation (P = .038) cohorts. Patients in the high-risk CNS-PINK group who were treated with SMILE or SMILE-like regimens with ID-MTX (S-ID-MTX) displayed a lower incidence rate of CNS relapse than did those who received other regimens without ID-MTX in the training cohort (P = .029). The CNS-PINK was demonstrated its strong predictability of CNS relapse in ENKTL patients. The effectiveness of S-ID-MTX in preventing CNS events in high-risk CNS-PINK patients should be verified in future studies.