High-dose cytarabine salvage therapy for recurrent primary CNS lymphoma
High-dose cytarabine salvage therapy for recurrent primary CNS lymphoma
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DOI：
10.1007/s11060-015-1994-8
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发表时间：
2016-02-01
影响因子：
3.9
通讯作者：
Chamberlain, Marc C.
中科院分区：
文献类型：
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作者：
Chamberlain, Marc C.
复发的原发中枢神经系统淋巴瘤(PCNSL)的治疗虽然没有标准化，但通常采用全脑放射治疗、大剂量甲氨蝶呤再治疗或烷化化疗。大剂量阿糖胞苷(HD-Arac)一直被认为是PCNSL的一种活性药物，但关于复发情况下单药活性的信息有限。对14例复发的PCNSL患者(男性10例，女性4例：中位年龄60岁)进行了回顾分析，这些患者在第二次复发时接受了单一药物HD-ARAC的治疗。HD-Arac剂量为3gm/m(2)，每12h静脉滴注3h，共4次(定义为一个疗程)。在HD-Arac结束时给予GM-CSF。每4周对患者进行临床和放射学评估。常见的3级或4级毒性包括血小板减少(11例，79%)、贫血(10例，71%)、乏力(8例，57%)、粘膜炎(8例，57%)、中性粒细胞减少(8例，57%)和中性粒细胞减少症(5例，36%)。没有患者因毒性而停止治疗，也没有任何与治疗相关的死亡。HD-Arac治疗效果最好的是稳定期6例(43%)，部分缓解5例(36%)，进展期3例(21%)。中位无进展生存期3个月(范围2~5个月；95%可信区间2~4个月)，6个月无进展生存率为0%。发病后中位生存期为12个月(范围3-18个月以上；95%可信区间为3-15个月)。单一药物HD-Arac在复发的PCNSL中活性有限，在这项小型回顾性研究中与显著的毒性有关。
Treatment of recurrent primary CNS lymphoma (PCNSL) though not standardized most often utilizes whole brain radiotherapy, re-challenge with high-dose methotrexate, or administration of an alkylating chemotherapy. High-dose cytarabine (HD-araC) has been advocated as an active agent in PCNSL but limited information exists regarding single agent activity in the recurrent setting. A retrospective review of 14 patients (10 males, 4 females: median age 60 years) with recurrent PCNSL treated at second recurrence with single agent HD-araC. HD-araC was administered at 3gm/m(2) over a 3-h infusion every 12 h for a total of 4 doses (defined as a cycle of therapy). GM-CSF was administered at conclusion of HD-araC. Patients were clinically and radiographically evaluated every 4-weeks. Common toxicity criteria Grade 3 or 4 toxicity included thrombocytopenia (11 patients; 79 %), anemia (10; 71 %), fatigue (8; 57 %), mucositis (8; 57 %), neutropenia (8; 57 %) and neutropenic fever (5; 36 %). No patient discontinued therapy due to toxicity nor were there any treatment-related deaths. Best response to HD-araC was stable disease in 6 patients (43 %), partial response in 5 (36 %) and progressive disease in 3 (21 %). Median progression free survival 3 months (range 2-5 months; 95 % CI 2-4 months) and progression free survival was 0 % at 6-months. Median survival after onset of HD-araC was 12 months (range 3-18+ months; 95 % CI 3-15 months). Single agent HD-araC has limited activity in recurrent PCNSL and is associated with significant toxicity in this small retrospective study.