Central nervous system involvement in intravascular large B-cell lymphoma: A retrospective analysis of 109 patients
Central nervous system involvement in intravascular large B-cell lymphoma: A retrospective analysis of 109 patients
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DOI：
10.1111/j.1349-7006.2010.01555.x
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发表时间：
2010-06-01
期刊：
影响因子：
5.7
通讯作者：
Kinoshita, Tomohiro
中科院分区：
文献类型：
--
作者：
Shimada, Kazuyuki;Murase, Takuhei;Kinoshita, Tomohiro
血管内大B细胞淋巴瘤(IVLBCL)是一种罕见的疾病，确诊时中枢神经系统(CNS)受累的发生率很高。为了评估IVLBCL的中枢神经系统受累，特别是复发，包括治疗进展和复发，我们回顾分析了109例接受或不使用利妥昔单抗化疗的IVLBCL患者。在82例(75%)初诊时无中枢神经系统受累的患者中，3年后CNS复发的风险为25%，存活患者的中位随访期为39个月(范围为2-158个月)。在27例(25%)首次诊断为中枢神经系统受累的患者中，1年内CNS复发的风险为25%，存活患者的中位随访期为18个月(范围为10-77个月)。确诊时有中枢神经系统受累的患者，从确诊到中枢神经系统复发的时间往往较短。在接受化疗的患者中，使用利妥昔单抗和不使用利妥昔单抗在中枢神经系统复发风险方面没有显著差异。在多因素分析中，初诊时皮肤受累是诊断时未累及中枢神经系统的患者中枢神经系统复发的预测因素(危险比，5.27；95%可信区间，1.59~17.4；P=0.007)。初诊时无中枢神经系统受累的患者2年后CNS复发生存率为12%。中枢神经系统复发是IVLBCL患者的严重并发症，应建立中枢神经系统受累的最佳策略，以进一步改善利妥昔单抗时代的临床结果。(癌症科学2010)。
Intravascular large B-cell lymphoma (IVLBCL) is a rare disease entity with a high incidence of central nervous system (CNS) involvement at diagnosis. To evaluate CNS involvement, particularly recurrence including progression on therapy and relapse of IVLBCL, we retrospectively analyzed 109 patients with IVLBCL receiving chemotherapies with or without rituximab. In 82 patients (75%) without CNS involvement at initial diagnosis, risk of CNS recurrence at 3 years was 25% with a median follow-up in survivors of 39 months (range, 2-158 months). In 27 patients (25%) with CNS involvement at initial diagnosis, risk of CNS recurrence at 1 year was 25% with a median follow-up in survivors of 18 months (range, 10-77 months). Duration from diagnosis to CNS recurrence tended to be short in patients with CNS involvement at diagnosis. No significant difference in risk of CNS recurrence was found between patients receiving chemotherapies with or without rituximab. On multivariate analysis skin involvement at initial diagnosis was identified as a predictive factor for CNS recurrence in patients without CNS involvement at diagnosis (hazard ratio, 5.27; 95% confidence interval, 1.59-17.4; P = 0.007). Survival rate after CNS recurrence at 2 years was 12% in patients without CNS involvement at diagnosis. Central nervous system recurrence is a serious complication in IVLBCL patients and optimal strategies for CNS involvement should be established to obtain further improvements to clinical outcomes in the rituximab era. (Cancer Sci 2010).