{"title":"采用高剂量甲氨蝶呤和鞘内化疗预防中枢神经系统可提高中枢神经系统复发风险高的DLBCL患者的生存率。","authors":"Yuri Miyazawa, Akihiko Yokohama, Takuma Ishizaki, Takayuki Saitoh, Akio Saito, Kohtaro Toyama, Takeki Mitsui, Kayoko Murayama, Hidemi Ogura, Norifumi Tsukamoto, Hiroshi Handa","doi":"10.1007/s12185-025-04055-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Central nervous system (CNS) prophylaxis is recommended for patients with diffuse large B-cell lymphoma (DLBCL) who are at high risk of CNS relapse. This study aimed to determine the impact of CNS prophylaxis on CNS relapse rates and overall survival (OS) in this patient population, as well as the optimal method for CNS prophylaxis.</p><p><strong>Methods: </strong>This was a retrospective analysis of 178 patients with DLBCL at high risk of CNS relapse who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) or its derivatives with (N = 60) or without (N = 118) CNS prophylaxis.</p><p><strong>Results: </strong>The 2-year CNS relapse rate was 17.6% in the all-prophylaxis group (HD-MTX 17.4%, IT 48.1%, and HD-MTX + IT 6.2%) and 13.0% in the non-prophylaxis group, with no significant difference between groups. However, HD-MTX + IT decreased the risk of CNS relapse. After a median follow-up of 72.8 months, HD-MTX + IT addition significantly improved the 5-year OS (HD-MTX 73.5%, IT 44.4%, HD-MTX + IT 93.2%; non-prophylaxis group 58.0%; p = 0.013). This advantage was maintained in the multivariate analysis (hazard ratio: 0.160; 95% confidence interval: 0.039-0.663; p = 0.012).</p><p><strong>Conclusions: </strong>CNS prophylaxis with HD-MTX + IT improved the prognosis of patients with DLBCL at high risk of CNS relapse.</p>","PeriodicalId":13992,"journal":{"name":"International Journal of Hematology","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"CNS prophylaxis with high-dose methotrexate and intrathecal chemotherapy improves survival in DLBCL with high CNS relapse risk.\",\"authors\":\"Yuri Miyazawa, Akihiko Yokohama, Takuma Ishizaki, Takayuki Saitoh, Akio Saito, Kohtaro Toyama, Takeki Mitsui, Kayoko Murayama, Hidemi Ogura, Norifumi Tsukamoto, Hiroshi Handa\",\"doi\":\"10.1007/s12185-025-04055-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Central nervous system (CNS) prophylaxis is recommended for patients with diffuse large B-cell lymphoma (DLBCL) who are at high risk of CNS relapse. This study aimed to determine the impact of CNS prophylaxis on CNS relapse rates and overall survival (OS) in this patient population, as well as the optimal method for CNS prophylaxis.</p><p><strong>Methods: </strong>This was a retrospective analysis of 178 patients with DLBCL at high risk of CNS relapse who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) or its derivatives with (N = 60) or without (N = 118) CNS prophylaxis.</p><p><strong>Results: </strong>The 2-year CNS relapse rate was 17.6% in the all-prophylaxis group (HD-MTX 17.4%, IT 48.1%, and HD-MTX + IT 6.2%) and 13.0% in the non-prophylaxis group, with no significant difference between groups. However, HD-MTX + IT decreased the risk of CNS relapse. After a median follow-up of 72.8 months, HD-MTX + IT addition significantly improved the 5-year OS (HD-MTX 73.5%, IT 44.4%, HD-MTX + IT 93.2%; non-prophylaxis group 58.0%; p = 0.013). This advantage was maintained in the multivariate analysis (hazard ratio: 0.160; 95% confidence interval: 0.039-0.663; p = 0.012).</p><p><strong>Conclusions: </strong>CNS prophylaxis with HD-MTX + IT improved the prognosis of patients with DLBCL at high risk of CNS relapse.</p>\",\"PeriodicalId\":13992,\"journal\":{\"name\":\"International Journal of Hematology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-08-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Hematology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s12185-025-04055-4\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Hematology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12185-025-04055-4","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：中枢神经系统（CNS）复发风险高的弥漫大b细胞淋巴瘤（DLBCL）患者推荐中枢神经系统（CNS）预防。本研究旨在确定CNS预防对该患者群体中CNS复发率和总生存率（OS）的影响，以及CNS预防的最佳方法。方法：回顾性分析178例高危中枢神经系统复发的DLBCL患者，这些患者分别接受利美昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松龙（R-CHOP）或其衍生物（N = 60）或未（N = 118）中枢神经系统预防治疗。结果：全预防组2年中枢神经系统复发率为17.6% (HD-MTX 17.4%, IT 48.1%, HD-MTX + IT 6.2%)，非预防组2年中枢神经系统复发率为13.0%，组间差异无统计学意义。然而，HD-MTX + IT降低了中枢神经系统复发的风险。中位随访72.8个月后，HD-MTX + IT组5年OS显著改善（HD-MTX 73.5%, IT 44.4%, HD-MTX + IT 93.2%；非预防组58.0%;p = 0.013）。这一优势在多变量分析中得以保持（风险比：0.160；95%可信区间：0.039-0.663;p = 0.012）。结论：采用HD-MTX + IT预防中枢神经系统可改善中枢神经系统复发高危DLBCL患者的预后。
CNS prophylaxis with high-dose methotrexate and intrathecal chemotherapy improves survival in DLBCL with high CNS relapse risk.
Objective: Central nervous system (CNS) prophylaxis is recommended for patients with diffuse large B-cell lymphoma (DLBCL) who are at high risk of CNS relapse. This study aimed to determine the impact of CNS prophylaxis on CNS relapse rates and overall survival (OS) in this patient population, as well as the optimal method for CNS prophylaxis.
Methods: This was a retrospective analysis of 178 patients with DLBCL at high risk of CNS relapse who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) or its derivatives with (N = 60) or without (N = 118) CNS prophylaxis.
Results: The 2-year CNS relapse rate was 17.6% in the all-prophylaxis group (HD-MTX 17.4%, IT 48.1%, and HD-MTX + IT 6.2%) and 13.0% in the non-prophylaxis group, with no significant difference between groups. However, HD-MTX + IT decreased the risk of CNS relapse. After a median follow-up of 72.8 months, HD-MTX + IT addition significantly improved the 5-year OS (HD-MTX 73.5%, IT 44.4%, HD-MTX + IT 93.2%; non-prophylaxis group 58.0%; p = 0.013). This advantage was maintained in the multivariate analysis (hazard ratio: 0.160; 95% confidence interval: 0.039-0.663; p = 0.012).
Conclusions: CNS prophylaxis with HD-MTX + IT improved the prognosis of patients with DLBCL at high risk of CNS relapse.
期刊介绍：
The International Journal of Hematology, the official journal of the Japanese Society of Hematology, has a long history of publishing leading research in hematology. The journal comprises articles that contribute to progress in research not only in basic hematology but also in clinical hematology, aiming to cover all aspects of this field, namely, erythrocytes, leukocytes and hematopoiesis, hemostasis, thrombosis and vascular biology, hematological malignancies, transplantation, and cell therapy. The expanded [Progress in Hematology] section integrates such relevant fields as the cell biology of stem cells and cancer cells, and clinical research in inflammation, cancer, and thrombosis. Reports on results of clinical trials are also included, thus contributing to the aim of fostering communication among researchers in the growing field of modern hematology. The journal provides the best of up-to-date information on modern hematology, presenting readers with high-impact, original work focusing on pivotal issues.
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