Management and outcome of primary CNS lymphoma in the modern era An LOC network study
Management and outcome of primary CNS lymphoma in the modern era An LOC network study
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DOI：
10.1212/wnl.0000000000008900
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发表时间：
2020-03-10
期刊：
影响因子：
9.9
通讯作者：
Gyan, Emmanuel
中科院分区：
文献类型：
--
作者：
Houillier, Caroline;Soussain, Carole;Gyan, Emmanuel
目的原发性中枢神经系统淋巴瘤（PCNSL）的临床研究较少。我们的目的是分析，在一项全国范围内的人口为基础的研究，目前的医疗实践中的管理PCNSL。方法法国眼脑淋巴瘤网络（OCL）数据库前瞻性地记录了来自32个法国中心的所有新诊断的PCNSL病例。回顾性分析了2011年至2016年期间诊断的患者数据。结果：我们确定了1,002名免疫功能正常的患者（43%年龄>70岁，中位Karnofsky体力状态[KPS] 60）。92%的病例的一线治疗是高剂量的甲氨蝶呤化疗，随着时间的推移，利妥昔单抗的使用越来越多（66%）。年龄60岁的患者中，WBRT和HCT-ASCT巩固治疗分别仅占9%和2%。初始化疗的完全缓解率为50%。中位无进展生存期为10.5个月。对于复发，分别为55%、17%、10%和18%的患者提供二线化疗、HCT-ASCT、WBRT和姑息治疗。中位、2年和5年总生存期分别为25.3个月、51%和38%（60年：15.4个月、44%和28%）。在多因素分析中，年龄、KPS、性别和对诱导CT的反应是独立的预后因素。结论我们的研究证实了PCNSL人群中老年人比例的增加，并显示了与临床试验报告的结果相当的结果，反映了最近PCNSL治疗进展的显着应用。
Objective Real-life studies on patients with primary CNS lymphoma (PCNSL) are scarce. Our objective was to analyze, in a nationwide population-based study, the current medical practice in the management of PCNSL. Methods The French oculo-cerebral lymphoma network (LOC) database prospectively records all newly diagnosed PCNSL cases from 32 French centers. Data of patients diagnosed between 2011 and 2016 were retrospectively analyzed. Results We identified 1,002 immunocompetent patients (43% aged >70 years, median Karnofsky Performance Status [KPS] 60). First-line treatment was high-dose methotrexate-based chemotherapy in 92% of cases, with an increasing use of rituximab over time (66%). Patients 60 years of age, WBRT and HCT-ASCT consolidation were administered in only 9% and 2%, respectively. The complete response rate to initial chemotherapy was 50%. Median progression-free survival was 10.5 months. For relapse, second-line chemotherapy, HCT-ASCT, WBRT, and palliative care were offered to 55%, 17%, 10%, and 18% of patients, respectively. The median, 2-year, and 5-year overall survival was 25.3 months, 51%, and 38%, respectively (60 years: 15.4 months, 44%, and 28%). Age, KPS, sex, and response to induction CT were independent prognostic factors in multivariate analysis. Conclusions Our study confirms the increasing proportion of elderly within the PCNSL population and shows comparable outcome in this population-based study with those reported by clinical trials, reflecting a notable application of recent PCNSL advances in treatment.