Natural History of CNS Relapse in Patients With Aggressive Non-Hodgkin's Lymphoma: A 20-Year Follow-Up Analysis of SWOG 8516-The Southwest Oncology Group
Natural History of CNS Relapse in Patients With Aggressive Non-Hodgkin's Lymphoma: A 20-Year Follow-Up Analysis of SWOG 8516-The Southwest Oncology Group
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DOI：
10.1200/jco.2008.16.8021
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发表时间：
2009-01-01
影响因子：
45.3
通讯作者：
Fisher, Richard I.
中科院分区：
文献类型：
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作者：
Bernstein, Steven H.;Unger, Joseph M.;Fisher, Richard I.
目的探讨新发侵袭性淋巴瘤患者中枢神经系统复发的发生率、自然病史和危险因素预测，并评价首发骨髓（BM）受损伤患者中枢神经系统预防的疗效。研究人员对899例接受西南肿瘤组方案8516治疗的符合条件的侵袭性淋巴瘤患者进行了20年随访数据分析，其中包括CHOP（环磷酰胺、阿霉素、长春新碱、泼尼松）、macp - b（甲氨喋呤、阿霉素、环磷酰胺、长春新碱、泼尼松和博莱霉素）、ProMACE（泼尼松、甲氨喋呤、阿霉素、环磷酰胺、etoposide）-CytaBOM（阿糖胞苷、博莱霉素、长春新碱、博莱松和博莱松）的随机试验。甲氨蝶呤)和m-BACOD（甲氨蝶呤、博来霉素、环磷酰胺、依托泊苷）。BM患者随机分配接受ProMACE-CytaBOM（63例）或m-BACOD（58例）的患者接受CNS预防，而随机分配接受CHOP或MACOP-B的患者则不接受CNS预防。结果中枢神经系统复发少见（899例患者中25例），累计发病率为2.8%。中枢神经系统复发发生较早（中位复发时间，诊断后5.4个月）。事实上，25例中枢神经系统复发患者中有20例在化疗期间或化疗完成后6个月内复发。结外部位数量和国际预后指数可预测中枢神经系统复发。在诊断时BM受累的患者中，中枢神经系统预防没有显著的益处；然而，由于事件数量较少，这种分析的能力是有限的。结论中枢神经系统事件发生早，提示患者初诊时为亚临床疾病。因此，在诊断时更好地检测和治疗亚临床中枢神经系统疾病患者的策略有望降低中枢神经系统复发的发生率，而不会使那些不打算中枢神经系统复发的患者接受不必要的和潜在毒性的预防策略。
Purpose To investigate the incidence, natural history, and risk factors predictive of CNS relapse in patients with de novo aggressive lymphomas and to evaluate the efficacy of CNS prophylaxis in patients with initial bone marrow ( BM) involvement.Patients and Methods We conducted an analysis of CNS events from 20-year follow-up data on 899 eligible patients with aggressive lymphoma treated on Southwest Oncology Group protocol 8516, a randomized trial of CHOP ( cyclophosphamide, doxorubicin, vincristine, prednisone), MACOP-B ( methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin), ProMACE ( prednisone, methotrexate, doxorubicin, cyclophosphamide, etoposide)-CytaBOM ( cytarabine, bleomycin, vincristine, methotrexate), and m-BACOD ( methotrexate, bleomycin, cyclophosphamide, etoposide). Patients with BM involvement randomly assigned to receive ProMACE-CytaBOM ( 63 patients) or m-BACOD ( 58 patients) were to receive CNS prophylaxis, whereas those randomly assigned to receive CHOP or MACOP-B did not.Results CNS relapse is uncommon ( 25 of 899 patients), with a cumulative incidence of 2.8%. CNS relapse occurs early ( median time to relapse, 5.4 months from diagnosis). Indeed, 20 of 25 patients with CNS relapse relapsed during chemotherapy, or within 6 months of completion. The number of extranodal sites and the International Prognostic Index were predictive of CNS relapse. There was no significant benefit of CNS prophylaxis in patients with BM involvement at diagnosis; however, given the small number of events, the power of this analysis is limited.Conclusion The early occurrence of CNS events suggests that these patients had subclinical disease at initial diagnosis. As such, strategies to better detect and treat patients with subclinical CNS disease at diagnosis would be anticipated to result in a decrease in the incidence of CNS relapse, without subjecting those patients not destined for CNS relapse to unnecessary and potentially toxic prophylaxis strategies.