Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma: An intent-to-treat analysis
Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma: An intent-to-treat analysis
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DOI：
10.1200/jco.2003.05.024
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发表时间：
2003-11-15
影响因子：
45.3
通讯作者：
DeAngelis, LM
中科院分区：
文献类型：
--
作者：
Abrey, LE;Moskowitz, CH;DeAngelis, LM
目的：评估新诊断原发性中枢神经系统淋巴瘤（PCNSL）患者接受以甲氨蝶呤为基础的强化化疗后联合大剂量化疗（HDT）和自体干细胞拯救的安全性和有效性。患者和方法：28例患者接受诱导化疗，使用大剂量全身甲氨蝶呤（3.5 g/m2）和阿糖胞苷（3 g/m2，每日1次，持续2 d）。14例化疗敏感性疾病明显的神经影像学，然后接受高剂量的治疗，使用卡莫司汀，依托泊苷，阿糖胞苷，马法兰与自体干细胞rescue.Results：诱导期化疗的客观反应率为57%，中位总生存期尚未评估，中位随访时间为28个月。所有患者的总体中位无事件生存时间为5.6个月，14例接受移植的患者为9.3个月。这14例患者中有6例（43%）在末次随访时保持无疾病状态。治疗耐受性良好;有1例移植相关死亡。前瞻性的神经心理学评价没有发现证据的治疗相关的neuropsychiatrice.Conclusion：这种治疗方法是可行的，在新诊断的PCNSL患者没有显着相关的神经毒性的证据。虽然移植结果与侵袭性或预后不良的系统性淋巴瘤患者相似，但诱导化疗的低应答率和HDT后不久复发的患者数量表明，可能需要更积极的诱导化疗。(C)2003年，美国临床肿瘤学会。
Purpose: To assess the safety and efficacy of intensive methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma (PCNSL).Patients and Methods: Twenty-eight patients received induction chemotherapy using high-dose systemic methotrexate (3.5 g/m(2)) and cytarabine (3 g/m(2) daily for 2 days). Fourteen patients with chemosensitive disease evident on neuroimaging then received high-dose therapy using carmustine, etoposide, cytarabine, and melphalan with autologous stem-cell rescue.Results: The objective response rate to the induction-phase chemotherapy was 57%, and median overall survival is not yet assessable, with a median follow-up time of 28 months. The overall median event-free survival time is 5.6 months for all patients and 9.3 months for 14 patients who underwent transplantation. Six of these 14 patients (43%) remained disease-free at last follow-up. Treatment was well tolerated; there was one transplantation-related death. Prospective neuropsychologic evaluations have revealed no evidence of treatment-related neurotoxicity.Conclusion: This treatment approach is feasible in patients with newly diagnosed PCNSL without evidence of significant related neurotoxicity. Although the transplantation results are similar to those achieved in patients with aggressive or poor-prognosis systemic lymphoma, the low response rate to induction chemotherapy and the significant number of patients who experienced relapse soon after HDT suggest that more aggressive induction chemotherapy may be warranted. (C) 2003 by American Society of Clinical Oncology.