Stand-alone intrathecal central nervous system (CNS) prophylaxis provide unclear benefit in reducing CNS relapse risk in elderly DLBCL patients treated with R-CHOP and is associated increased infection-related toxicity
Stand-alone intrathecal central nervous system (CNS) prophylaxis provide unclear benefit in reducing CNS relapse risk in elderly DLBCL patients treated with R-CHOP and is associated increased infection-related toxicity
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DOI：
10.1111/bjh.16070
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发表时间：
2019-10-01
影响因子：
6.5
通讯作者：
Hatton, Chris S. R.
中科院分区：
文献类型：
--
作者：
Eyre, Toby A.;Kirkwood, Amy A.;Hatton, Chris S. R.
2-5% 的弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者在 R-CHOP（利妥昔单抗、环磷酰胺、阿霉素、长春新碱、泼尼松龙）后出现中枢神经系统 (CNS) 复发。许多年龄 >= 70 岁的患者不适合大剂量甲氨蝶呤 (HDMTX) 预防，因此经常接受单独的鞘内预防。中枢神经系统国际预后指数（CNS-IPI）是一项临床中枢神经系统复发风险评分，尚未在老年患者中进行专门验证。 CNS 预防对于 70 岁以上患者的价值仍不确定。在英国 8 个中心（2009-2018 年）收集了 690 名连续接受 R-CHOP 治疗的年龄≥ 70 岁的 DLBCL 患者的数据。根据医生的喜好进行中枢神经系统预防。中位年龄为 77 中心点 2 年，中位随访时间为 2 中心点 8 年。 CNS-IPI 为 60 个中心点 1% 中的 1-3 个、23 个中心点中的 4 个 8%、13 个中心点中的 5 个 0% 和 3 个中心点 3% 中的 6 个。肾脏和/或肾上腺 (R/A) 受累发生在 8 个中心点，占 8%。两年总体 CNS 复发率为 2 中心点 6%，根据 CNS-IPI，1-3:0 中心点 8%、4:3 中心点 6%、5:3 中心点 8% 和 6:21 中心点 8%。 R/A 的两年 CNS 复发率为 10 中心点 0%。当排除 HDMTX (n = 31) 患者时，根据 CNS-IPI，鞘内预防效果的未调整/调整 CNS 复发没有变化。 CNS-IPI 对接受 R-CHOP 治疗的老年 DLBCL 患者有效，其中 CNS-IPI 6 和 R/A 受累的患者风险最高。我们观察到单独的鞘内预防没有明显的益处，但观察到在 R-CHOP 期间进行鞘内预防时，感染相关入院的风险独立增加。
Central nervous system (CNS) relapse following R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) occurs in 2-5% of patents with diffuse large B-cell lymphoma (DLBCL). Many patients aged >= 70 years are unsuitable for high-dose methotrexate (HDMTX) prophylaxis and therefore often receive stand-alone intrathecal prophylaxis. The CNS international prognostic index (CNS-IPI) is a clinical CNS relapse risk score that has not specifically been validated in elderly patients. The value of CNS prophylaxis in patients aged >= 70 years remains uncertain. Data on 690 consecutively R-CHOP-treated DLBCL patients aged >= 70 years were collected across 8 UK centres (2009-2018). CNS prophylaxis was administered per physician preference. Median age was 77 center dot 2 years and median follow-up was 2 center dot 8 years. CNS-IPI was 1-3 in 60 center dot 1%, 4 in 23 center dot 8%, 5 in 13 center dot 0% and 6 in 3 center dot 3%. Renal and/or adrenal (R/A) involvement occurred in 8 center dot 8%. Two-year overall CNS relapse incidence was 2 center dot 6% and according to CNS-IPI, 1-3:0 center dot 8%, 4:3 center dot 6%, 5:3 center dot 8% and 6:21 center dot 8%. Two-year CNS relapse incidence for R/A was 10 center dot 0%. When excluding HDMTX (n = 31) patients, there remained no change in unadjusted/adjusted CNS relapse for intrathecal prophylaxis effect according to CNS-IPI. CNS-IPI is valid in elderly R-CHOP-treated DLBCL patients, with the highest risk in those with CNS-IPI 6 and R/A involvement. We observed no clear benefit for stand-alone intrathecal prophylaxis but observed an independent increased risk of infection-related admission during R-CHOP when intrathecal prophylaxis was administered.