A single institutional retrospective evaluation for younger patients with primary central nervous lymphomas on a modified R-MPV regimen followed by radiotherapy and high dose cytarabine
A single institutional retrospective evaluation for younger patients with primary central nervous lymphomas on a modified R-MPV regimen followed by radiotherapy and high dose cytarabine
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DOI：
10.3960/jslrt.17012
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发表时间：
2017-01-01
影响因子：
1.5
通讯作者：
Chiba, Shigeru
中科院分区：
文献类型：
--
作者：
Hattori, Keiichiro;Sakata-Yanagimoto, Mamiko;Chiba, Shigeru
我们对2008年1月至2016年11月在筑波大学医院新诊断的60岁以下(N=10，中位年龄54.5岁)的原发性中枢神经系统淋巴瘤(PCNSL)患者进行了回顾性分析。所有的患者都计划接受单一的方案，而不是登记参加任何临床试验。这是基于纪念斯隆-凯特琳癌症中心(MSKCC)的2期研究；利妥昔单抗、甲氨蝶呤、原卡巴津和长春新碱诱导化疗(R-MPV)(5至7个周期)，然后是全脑放射治疗(RD-WBRT)(23.4GY)和作为巩固的两个大剂量阿糖胞苷(HD-AC)周期。中位年龄54.5岁，中位随访时间33.1个月。3年总生存率和无进展生存率分别为69%(95%可信区间31~89%)和56%(95%可信区间20~81%)。分别未达到OS和PFS的中位数。急性和延迟性毒性是可控的。特别是通过R-MPV诱导化疗获得CR的7例患者的OS和PFS显著优秀(3年OS，100%；3年PFS，80%)，这意味着在完成治疗后大部分CR患者可能实现持久的疾病控制。另一方面，在此治疗期间有疾病进展的3名患者均在确诊后1年内死于疾病进展，但未达到CR。确定在R-MPV诱导化疗中有失败风险的患者是重要的，这可能使我们能够考虑潜在的更有效的方案。
We conducted a retrospective analysis of patients younger than 60 years (N = 10, median age 54.5) with newly diagnosed primary central nervous system lymphoma (PCNSL) at the University of Tsukuba Hospital from January 2008 to November 2016. All the patients were scheduled to receive a single regimen without registration to any clinical trials. This was based on a phase 2 study by Memorial Sloan-Kettering Cancer Center (MSKCC); induction chemotherapy with rituximab, methotrexate, procarbazine, and vincristine (R-MPV) (five to seven cycles), followed by whole-brain radiotherapy (rd-WBRT) (23.4 Gy) and two high-dose cytarabine (HD-AC) cycles as a consolidation. The median age was 54.5 years, and median follow up duration was 33.1 months. The 3-year overall survival (OS) and progression-free survival (PFS) were 69% (95% CI 31-89%) and 56% (95% CI 20-81%). The median OS and PFS were not reached, respectively. Acute and delayed toxicities were manageable. In particular, OS and PFS of seven patients who achieved CR by the R-MPV induction chemotherapy were significantly superb (3-year OS, 100%; 3-year PFS, 80%), implying that a large proportion of patients in CR after the completion of this treatment may achieve durable disease control.On the other hand, all of the three patients who had progressive disease during this treatment died of disease progression within 1 year after diagnosis without achieving CR. Identifying the patients having a risk of failure in the R-MPV induction chemotherapy is important, and may allow us to consider a potentially more effective regimen.