Immunochemotherapy with intensive consolidation for primary CNS lymphoma: a pilot study and prognostic assessment by diffusion-weighted MRI.
Immunochemotherapy with intensive consolidation for primary CNS lymphoma: a pilot study and prognostic assessment by diffusion-weighted MRI.
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DOI：
10.1158/1078-0432.ccr-11-0625
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发表时间：
2012-02-15
期刊：
影响因子：
--
通讯作者：
Rubenstein JL
中科院分区：
文献类型：
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作者：
Wieduwilt MJ;Valles F;Issa S;Behler CM;Hwang J;McDermott M;Treseler P;O'Brien J;Shuman MA;Cha S;Damon LE;Rubenstein JL
我们评估了一种原发性中枢神经系统 (CNS) 淋巴瘤 (PCNSL) 的新疗法，使用大剂量甲氨蝶呤、替莫唑胺和利妥昔单抗 (MT-R) 诱导免疫化疗，随后输注依托泊苷和大剂量阿糖胞苷 (EA) 强化巩固治疗。此外，我们还评估了采用该方案治疗的患者的弥散加权磁共振成像 (DW-MRI) 得出的最小表观弥散系数 (ADCmin) 的预后价值。 31 名患者（中位年龄 61 岁；中位 KPS 60）每 14 天接受甲氨蝶呤诱导，持续 8 个计划周期。前 6 个周期给予利妥昔单抗，奇数周期给予替莫唑胺。有反应或稳定 CNS 疾病的患者接受 EA 巩固治疗。治疗前DW-MRI用于计算对比增强病灶的ADCmin。 MT-R 诱导的完全缓解率为 52%。中位随访时间为 79 个月，2 年无进展生存率和总生存率分别为 45% 和 58%。接受 EA 巩固治疗的患者的 2 年无进展生存率和总生存率分别为 78% 和 93%。 EA 巩固治疗对另外 3 名同时患有中枢神经系统和全身性淋巴瘤的患者也有效。肿瘤 ADCmin <384 × 10−6 mm2/s 与较短的无进展生存期和总生存期显着相关。 MT-R 诱导有效且耐受性良好。 MT-R 随后进行 EA 巩固所产生的无进展和总生存结果与使用化疗随后进行全脑放疗巩固的治疗方案相当，但没有神经毒性的证据。与已建立的临床风险评分相比，DW-MRI 得出的肿瘤 ADCmin 为接受 MTR-EA 方案治疗的 PCNSL 患者提供了更好的预后信息。
We evaluated a novel therapy for primary central nervous system (CNS) lymphoma (PCNSL) using induction immunochemotherapy with high-dose methotrexate, temozolomide and rituximab (MT-R) followed by intensive consolidation with infusional etoposide and high-dose cytarabine (EA). In addition, we evaluated the prognostic value of the minimum apparent diffusion coefficient (ADCmin) derived from diffusion-weighted magnetic resonance imaging (DW-MRI) in patients treated with this regimen. Thirty-one patients (median age, 61; median KPS, 60) received induction with methotrexate every 14 days for 8 planned cycles. Rituximab was administered the first 6 cycles and temozolomide administered on odd-numbered cycles. Patients with responsive or stable CNS disease received EA consolidation. Pretreatment DW-MRI was used to calculate the ADCmin of contrast-enhancing lesions. The complete response rate for MT-R induction was 52%. At a median follow-up of 79 months, the 2-year progression-free and overall survival were 45% and 58%, respectively. For patients receiving EA consolidation, the 2-year progression-free and overall survival were 78% and 93%, respectively. EA consolidation was also effective in an additional 3 patients who presented with synchronous CNS and systemic lymphoma. Tumor ADCmin <384 × 10−6 mm2/s was significantly associated with shorter progression-free and overall survival. MT-R induction was effective and well-tolerated. MT-R followed by EA consolidation yielded progression-free and overall survival outcomes comparable to regimens using chemotherapy followed by whole-brain radiotherapy consolidation but without evidence of neurotoxicity. Tumor ADCmin derived from DW-MRI provided better prognostic information for PCNSL patients treated with the MTR-EA regimen than established clinical risk scores.