中枢神经系统多发性骨髓瘤（CNS-MM）患者接受中枢神经系统定向放射治疗的结果。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia Pub Date : 2024-11-22 DOI:10.1016/j.clml.2024.11.010

Gohar S. Manzar , Stephanie O. Dudzinski , Alison K. Yoder , Aaron Seo , Lewis F. Nasr , Hind Rafei , Melody R. Becnel , Krina K. Patel , Hans C. Lee , Gregory P. Kaufman , Mahmoud M. Gaballa , Jing Christine Ye , Neeraj Saini , Sheeba K. Thomas , Behrang Amini , Robert Z. Orlowski , Bouthaina S. Dabaja , Chelsea C. Pinnix , Jillian R. Gunther , Susan Y. Wu , Penny Q. Fang

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引用次数: 0

摘要

背景：累及中枢神经系统（CNS-MM）的多发性骨髓瘤预后差。我们报道CNS-MM用cns定向放射治疗（RT）治疗的结果。方法：回顾性分析2015年至2024年接受cns定向RT治疗的CNS-MM患者。CNS-MM被定义为有影像学上的脑膜或实质疾病，和/或病理性脑脊液受累。完全缓解（CR）是指脑脊液中没有非典型细胞或影像学疾病的消退。否则，患者根据影像学分为部分缓解（PR）或疾病稳定（SD）。采用Kaplan-Meier法估计生存率。结果：45例CNS-MM患者中，高危患者28例（62.2%）。CNS-MM诊断后中位总生存期（OS）为3.7个月（范围：0.4-52.2）。大多数患者（n = 22, 48.9%）接受了颅脊髓照射；9例接受全脑放疗（占20%），其余接受局灶性脑或脊柱放疗。中位剂量为20 Gy (2-30 Gy)，分10次（1-15次）。在进一步随访治疗效果之前，由于死亡或出院到安宁疗护（n = 24），只有21例（46.7%）患者在接受足够的脑脊液或放射学随访后可评估治疗效果。在这些可评估的患者中，14例（66.7%）患者出现了rt后CR， 5例（23.8%）患者出现了PR， 2例（9.5%）患者出现了SD。对于RT后出现CR的患者，从CNS-MM诊断起的中位OS为7.3个月（3-52.2）。局灶性脑CNS- mm与改善OS和获得CNS cr长期生存的可能性相关。结论：在一小部分高危人群CNS- mm患者中，包括RT在内的积极多模式治疗可诱导持久的CNS控制。

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Outcome of Patients With Central Nervous System Multiple Myeloma (CNS-MM) Treated With CNS-Directed Radiation Therapy

Background

The prognosis of multiple myeloma involving the central nervous system (CNS-MM) is poor. We report outcomes of CNS-MM treated with CNS-directed radiation therapy (RT).

Methods

We retrospectively reviewed patients with CNS-MM treated with CNS-directed RT from 2015 to 2024. CNS-MM was defined as having radiographic leptomeningeal or parenchymal disease, and/or pathologic CSF involvement. Complete response (CR) constituted having no atypical cells in CSF or resolution of radiographic disease. Otherwise, patients were categorized with partial response (PR) based on imaging, or stable disease (SD). The Kaplan-Meier method was used to estimate survival.

Results

Of 45 patients with CNS-MM, 28 (62.2%) had high-risk disease. Median overall survival (OS) was 3.7 months (range: 0.4-52.2) postdiagnosis of CNS-MM. Most patients (n = 22, 48.9%) underwent craniospinal irradiation; 9 received whole brain RT (20%), and the others received focal brain or spine RT. The median dose was 20 Gy (2-30 Gy) in 10 fractions (1-15). Due to death or discharge to hospice before further follow-up of treatment efficacy (n = 24), only 21 patients (46.7%) were evaluable post-RT with adequate CSF or radiographic follow-up. For these evaluable patients, post-RT CR occurred in 14 patients (66.7%), PR in 5 (23.8%), and SD in 2 (9.5%). For patients with CR after RT, the median OS was 7.3 months (3-52.2) from CNS-MM diagnosis. Focal brain CNS-MM associated with improved OS and likelihood of attaining long-term survival with CNS CR.

Conclusion

Aggressive multimodality therapy including RT may induce durable CNS control in a small subset of patients with CNS-MM, a high-risk population.

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来源期刊

Clinical Lymphoma, Myeloma & Leukemia ONCOLOGY-HEMATOLOGY

CiteScore

2.70

自引率

3.70%

发文量

1606

审稿时长

26 days

期刊介绍： Clinical Lymphoma, Myeloma & Leukemia is a peer-reviewed monthly journal that publishes original articles describing various aspects of clinical and translational research of lymphoma, myeloma and leukemia. Clinical Lymphoma, Myeloma & Leukemia is devoted to articles on detection, diagnosis, prevention, and treatment of lymphoma, myeloma, leukemia and related disorders including macroglobulinemia, amyloidosis, and plasma-cell dyscrasias. The main emphasis is on recent scientific developments in all areas related to lymphoma, myeloma and leukemia. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.