Sarah J Nagle, Nirav N Shah, Alex Ganetsky, Daniel J Landsburg, Sunita D Nasta, Anthony Mato, Stephen J Schuster, Ran Reshef, Donald E Tsai, Jakub Svoboda
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引用次数: 14
摘要
目的:描述无巩固治疗的利妥昔单抗、替莫唑胺和大剂量甲氨蝶呤治疗中枢神经系统淋巴瘤患者的长期预后。患者和方法:一项回顾性队列研究，连续46例原发性中枢神经系统淋巴瘤(PCNSL, 27例)或继发性弥漫性大b细胞淋巴瘤(DLBCL, 19例)患者，在第1天接受利妥昔单抗联合高剂量甲氨蝶呤(第1天和第15天)和替莫唑胺(第1天至第5天)治疗，28天周期，无进一步巩固。结果:中位随访时间为21.2个月。患者平均接受5个周期(范围1-15)。中位总生存期(OS)为26个月，中位无进展生存期为8.6个月。3年时，37%的患者存活且无疾病迹象。PCNSL患者的缓解率明显更高(ORR为81比47%;p = 0.015)和更长的中位OS (55.3 vs 4.8个月;结论:利妥昔单抗、替莫唑胺和甲氨蝶呤联合治疗PCNSL是一种有效的治疗方案，且无巩固治疗的毒副作用。
Long-term outcomes of rituximab, temozolomide and high-dose methotrexate without consolidation therapy for lymphoma involving the CNS.
Aim: To describe the long-term outcomes of patients with lymphoma in the CNS treated with rituximab, temozolomide and high-dose methotrexate without consolidation therapy.
Patients & methods: A retrospective cohort study of 46 consecutive patients with primary CNS lymphoma (PCNSL, 27 patients) or secondary CNS involvement of diffuse large B-cell lymphoma (DLBCL, 19 patients) who were treated with rituximab on day 1 in combination with high-dose methotrexate (days 1 and 15) and temozolomide (days 1-5) in 28-day cycles without further consolidation.
Results: Median follow-up was 21.2 months. Patients received a median of five cycles (range 1-15). Median overall survival (OS) was 26 months and median progression-free survival was 8.6 months. At 3 years, 37% of patients were alive and without evidence of disease. The patients with PCNSL had a significantly higher response rates (ORR 81 vs 47%; p = 0.015) and longer median OS (55.3 vs 4.8 months; p < 0.01) than those with secondary CNS DLBCL. Toxicities were mild and manageable.
Conclusion: The rituximab, temozolomide and methotrexate regimen is an effective therapy for patients with PCNSL without the toxicities typically associated with consolidation therapy.
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