Combination Therapy with Rituximab and Temozolomide for Recurrent and Refractory Primary Central Nervous System Lymphoma
Combination Therapy with Rituximab and Temozolomide for Recurrent and Refractory Primary Central Nervous System Lymphoma
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DOI：
10.3349/ymj.2011.52.6.1031
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发表时间：
2011-11-01
影响因子：
2.4
通讯作者：
Matsuno, Akira
中科院分区：
文献类型：
--
作者：
Murakami, Mineko;Fujimaki, Takamitsu;Matsuno, Akira
基于高剂量甲氨蝶呤的化疗延长了原发性中枢神经系统淋巴瘤（PCNSL）患者的生存期。然而，尽管在复发性难治性PCNSL中救助性治疗是必要的，但这还没有标准化。我们在此描述了利妥昔单抗和替莫唑胺（TMZ）联合治疗2例复发性难治性PCNSL患者的疗效。根据免疫组织化学研究，病例1具有非生发中心b细胞样（non-GCB）亚型，bcl-2阳性，O(6)-甲基鸟嘌呤- dna甲基转移酶（MGMT）阴性。病例2为GCB亚型、bcl-2-、MGMT+。由于MGMT阳性表达，病例2加用干扰素。在第三和第四个联合治疗周期后分别获得完全缓解和部分缓解。这种情况维持了12个月，毒性可接受。利妥昔单抗联合TMZ对不同免疫组化特征的肿瘤均有效。这种联合疗法值得在更大的人群中进一步研究。
High-dose methotrexate-based chemotherapy has extended survival in patients with primary central nervous system lymphoma (PCNSL). However, although salvage treatment is necessary in recurrent and refractory PCNSL, this has not been standardized. We herein describe the efficacy of a combination of rituximab and temozolomide (TMZ) in two consecutive patients with recurrent and refractory PCNSL. Based on the immunohistochemical study, case 1 had a non-germinal center B-cell-like (non-GCB) subtype, was positive for bcl-2 and negative for O(6)-methylguanine-DNA methyltransferase (MGMT. Case 2 was GCB subtype, bcl-2-, and MGMT+. Because of the positive expression of MGMT, interferon-beta was additionally given in case 2. Complete responses and partial responses were obtained after the third and fourth cycles of combination therapy, respectively. This was maintained for 12 months, with acceptable toxicity. The combination of rituximab and TMZ was effective in tumors with different immunohistochemical profiles. This combination therapy warrants further study in a larger population.