Consecutive single-institution case series of primary central nervous system lymphoma treated by R-MPV or high-dose methotrexate monotherapy
Consecutive single-institution case series of primary central nervous system lymphoma treated by R-MPV or high-dose methotrexate monotherapy
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DOI：
10.1093/jjco/hyaa073
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发表时间：
2020-09-01
影响因子：
2.4
通讯作者：
Nagane, Motoo
中科院分区：
文献类型：
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作者：
Sasaki, Nobuyoshi;Kobayashi, Keiichi;Nagane, Motoo
目的：以大剂量甲氨蝶呤为基础的化疗治疗原发性中枢神经系统淋巴瘤的最佳方案仍存在争议。我们进行了一项回顾性研究，旨在评估由利妥昔单抗、甲氨蝶呤、丙卡巴肼和长春新碱组成的联合免疫化疗联合或不联合全脑放疗和巩固阿糖胞苷的治疗结果，并与高剂量甲氨蝶呤单药治疗和全脑放疗进行比较。确定了杏林大学医院的长春新碱或高剂量甲氨蝶呤，并比较了缓解率和生存率。对利妥昔单抗、甲氨蝶呤、丙卡巴肼和长春新碱组的毒性、治疗后简易精神状态检查转变、卡诺夫斯基体能状态评分、Fazekas 量表和预后因素进行分析。 结果：95 名患者接受利妥昔单抗、甲氨蝶呤、丙卡巴肼和长春新碱 (n = 39) 或大剂量甲氨蝶呤 (n = 56）进行了分析。利妥昔单抗、甲氨蝶呤、丙卡巴肼和长春新碱组的完全缓解/完全缓解未确认率显着较高（74.4% vs. 15.4%，P < 0.001）。因此，利妥昔单抗、甲氨蝶呤、丙卡巴肼和长春新碱组的中位无进展生存期和总生存期均显着更长（中位无进展生存期：未达到与 14.75 个月，P < 0.001）（中位总生存期：未达到与 63.15 个月，P = 0.005）。尽管利妥昔单抗、甲氨蝶呤、丙卡巴肼和长春新碱以及巩固阿糖胞苷期间3/4级血液学毒性发生率较高，但3/4级感染发生率较低，并且没有观察到与治疗相关的死亡。卡诺夫斯基表现状态或简易精神状态检查的恶化很少见，除非疾病复发。尽管全脑放疗与Fazekas量表恶化相关，但其与卡诺夫斯基体力状态或简易精神状态检查恶化的相关性并不显着。结论：在本回顾性研究中，与毒性可控的高剂量甲氨蝶呤单药治疗相比，利妥昔单抗、甲氨蝶呤、丙卡巴肼和长春新碱显然有希望，并且有必要进一步研究。
Objective: The optimal regimen for use of high dose-methotrexate-based chemotherapy in primary central nervous system lymphoma is still under debate. We conducted a retrospective study to evaluate the treatment outcome of a combination immunochemotherapy consisting of rituximab, methotrexate, procarbazine and vincristine followed by with or without whole brain radiotherapy and consolidation cytarabine, in comparison with high dose-methotrexate monotherapy followed by full dose whole brain radiotherapy.Methods: Newly diagnosed primary central nervous system lymphoma patients treated with either rituximab, methotrexate, procarbazine and vincristine or high dose-methotrexate in Kyorin University Hospital were identified, and the response rates and survival were compared. Toxicities, post-treatment transition of Mini-Mental State Examination, Karnofsky performance status score, Fazekas scale and prognostic factors were analysed in the rituximab, methotrexate, procarbazine and vincristine group.Results: Ninety-five patients treated with rituximab, methotrexate, procarbazine and vincristine (n = 39) or high dose-methotrexate (n = 56) were analysed. The complete response/complete response unconfirmed rate was significantly higher in the rituximab, methotrexate, procarbazine and vincristine group (74.4 vs. 15.4%, P < 0.001). Accordingly, both median progression-free survival and overall survival were significantly longer in the rituximab, methotrexate, procarbazine and vincristine group (median progression-free survival: unreached vs. 14.75 months, P < 0.001) (median overall survival: unreached vs. 63.15 months, P = 0.005). Although the rate of grade 3/4 hematologic toxicities was high both during rituximab, methotrexate, procarbazine and vincristine and consolidation cytarabine, the rate of grade 3/4 infections was low, and no treatment related deaths were observed. Deterioration in Karnofsky performance status or Mini-Mental State Examination was rare, except on disease recurrence. Although whole brain radiotherapy was associated with Fazekas scale deterioration, its association with Karnofsky performance status or Mini-Mental State Examination deterioration was not significant.Conclusions: Rituximab, methotrexate, procarbazine and vincristine was apparently promising in comparison with high dose-methotrexate monotherapy with manageable toxicity in this retrospective study, and further investigation is warranted.