Final results of a multicenter trial addressing role of CSF flow cytometric analysis in NHL patients at high risk for CNS dissemination
Final results of a multicenter trial addressing role of CSF flow cytometric analysis in NHL patients at high risk for CNS dissemination
复制标题
DOI：
10.1182/blood-2012-04-423095
复制
发表时间：
2012-10-18
期刊：
影响因子：
20.3
通讯作者：
Pogliani, Enrico M.
中科院分区：
文献类型：
--
作者：
Benevolo, Giulia;Stacchini, Alessandra;Pogliani, Enrico M.
本前瞻性研究比较了174例新诊断的侵袭性非霍奇金淋巴瘤（NHL）患者的常规细胞学（CC）检查和脑脊液（CSF）基线样本的流式细胞术（FCM）的诊断和预后价值。FCM在174例患者中检出18例脑脊液肿瘤（10%），7例仅检出CC (4%, P < 0.001)；11例（14%）患者不一致（FCM+/CC-）。在中位随访46个月时，有64例全身性进展和10例中枢神经系统复发，包括2例全身性和中枢神经系统复发。与FCM- CSF患者（分别为39%和50%）相比，FCM- CSF患者的2年无进展生存率和总生存率显著高于FCM- CSF患者（62%和72%），2年CNS累计复发发生率分别为3%（95%置信区间[CI]， 0-7）和17% （95% CI, 0-34; P = 0.004）。FMC+/CC-患者与FCM+/CC-患者相比，CNS进展的风险明显更高（风险比= 8.16,95% CI, 1.45-46）。综上所述，高危NHL患者CSF中FCM阳性与CNS复发风险显著升高和预后较差相关。在FCM+患者中，建议联合使用具有较高中枢神经系统生物利用度的静脉注射药物和鞘内化疗，以防止中枢神经系统复发。(血。2012;120 (16):3222 - 3228)
This prospective study compared diagnostic and prognostic value of conventional cytologic (CC) examination and flow cytometry (FCM) of baseline samples of cerebrospinal fluid (CSF) in 174 patients with newly diagnosed aggressive non-Hodgkin lymphoma (NHL). FCM detected a neoplastic population in the CSF of 18 of 174 patients (10%), CC only in 7 (4%; P < .001); 11 patients (14%) were discordant (FCM+/CC-). At a median follow-up of 46 months, there were 64 systemic progressions and 10 CNS relapses, including 2 patients with both systemic and CNS relapses. Two-year progression-free and overall survival were significantly higher in patients with FCM- CSF (62% and 72%) compared with those FCM- CSF (39% and 50%, respectively), with a 2-year CNS relapse cumulative incidence of 3% (95% confidence interval [CI], 0-7) versus 17% (95% CI, 0-34; P = .004), respectively. The risk of CNS progression was significantly higher in FMC+/CC- versus FCM+/CC- patients (hazard ratio = 8.16, 95% CI, 1.45-46). In conclusion, FCM positivity in the CSF of patients with high-risk NHL is associated with a significantly higher CNS relapse risk and poorer outcome. The combination of IV drugs with a higher CNS bioavailability and intrathecal chemotherapy is advisable to prevent CNS relapses in FCM+ patients. (Blood. 2012;120(16):3222-3228)