Diffuse large B-cell lymphoma with central nervous system relapse: prognosis and risk factors according to retrospective analysis from a single-center experience
Diffuse large B-cell lymphoma with central nervous system relapse: prognosis and risk factors according to retrospective analysis from a single-center experience
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DOI：
10.1007/s12185-009-0289-2
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发表时间：
2009-06-01
影响因子：
2.1
通讯作者：
Ueda, Yasunori
中科院分区：
文献类型：
--
作者：
Shimazu, Yutaka;Notohara, Kenji;Ueda, Yasunori
利妥昔单抗治疗弥漫性大B细胞淋巴瘤（DLBCL）改善了疾病的总体预后。然而，中枢神经系统（CNS）的复发仍然是一个问题。我们研究了DLBCL患者的预后和CNS复发的危险因素。在1996年1月至2007年4月期间，共有403例在我们机构被诊断为DLBCL但未累及CNS的患者被纳入本研究。随后，42例发生CNS复发。通过病历审查收集临床信息。CNS复发的中位无病间隔为625天。CNS和CNS外受累病例复发后的平均生存期分别为513天和1，615天（P = 0.0004）。多变量分析确定年龄> 60岁（P = 0.031）、累及两个或多个结节部位（P = 0.040）、骨髓受累（P = 0.036）、血清乳酸脱氢酶（LDH）水平升高（P = 0.016）和CNS复发前未接受利妥昔单抗治疗（P = 0.027）是CNS复发的独立预测因素。我们已经证明，发生在高龄的DLBCL病例，涉及两个或多个结节部位或骨髓，或显示LDH升高，CNS复发的风险较高。利妥昔单抗可通过减少所有部位DLBCL的复发来预防CNS复发。应根据CNS复发的风险评估确定有效的CNS预防策略。
The introduction of rituximab for diffuse large B-cell lymphoma (DLBCL) has improved the disease's overall prognosis. However, relapse in the central nervous system (CNS) is still an issue. We investigated the prognosis and risk factors of CNS recurrence in DLBCL. A total of 403 patients who were diagnosed with DLBCL without CNS involvement between January 1996 and April 2007 at our institution were included in the study. Subsequently, 42 experienced CNS relapse. Clinical information was gathered by chart review. The median disease-free interval to CNS relapse was 625 days. The mean survival periods after relapse in the cases with CNS and extra-CNS involvement were 513 and 1,615 days, respectively (P = 0.0004). Multivariate analysis identified age > 60 years (P = 0.031), involvement in two or more extranodal sites (P = 0.040), bone marrow involvement (P = 0.036), an elevated serum lactate dehydrogenase (LDH) level (P = 0.016), and treatment without rituximab before CNS relapse (P = 0.027) as independent predictors of CNS relapse. We have shown that cases of DLBCL occurring in advanced age, involving two or more extranodal sites or the bone marrow, or showing an elevation of LDH have a higher risk of CNS relapse. Rituximab may prevent CNS relapse by reducing the recurrence of DLBCL at all sites. An effective CNS prophylaxis strategy should be determined according to the risk assessment of CNS relapse.