弥漫性大B细胞淋巴瘤的中枢神经系统预防:证据告诉我们什么?

IF 6.9 2区 医学 Q1 HEMATOLOGY
Jeffrey Lantz , Craig A. Portell , Emily C. Ayers
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引用次数: 0

摘要

弥漫性大b细胞淋巴瘤(DLBCL)继发性累及中枢神经系统(CNS)对DLBCL患者来说是一种罕见但往往是灾难性的事件。由于利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松(R-CHOP)治疗DLBCL的标准一线治疗不会跨越血脑屏障,降低中枢神经系统复发风险的一种方法是包括额外的药物,主要是甲氨蝶呤,用标准R-CHOP针对中枢神经系统,不同治疗医师的给药方式也有很大差异。这种做法源于几十年来非随机的、通常是回顾性的、结果不一致的数据。目前可用的工具和风险模型在预测哪些患者真正有继发性中枢神经系统复发风险方面并不精确,最近的大规模现实世界分析对这些长期做法提出了质疑。在一个缺乏任何前瞻性随机研究的领域,本综述综合了研究中枢神经系统预防在接受一线治疗的DLBCL患者中的效用的可用数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Central nervous system prophylaxis in diffuse large B-cell lymphoma: What does the evidence tell us?

Secondary involvement of the central nervous system (CNS) by diffuse large b-cell lymphoma (DLBCL) is a rare yet often catastrophic event for DLBCL patients. As standard first-line therapy for DLBCL with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) does not cross the blood-brain barrier, one approach to lessen the risk of CNS relapse has been to include additional agents, primarily methotrexate, directed at the CNS with standard R-CHOP although the timing, dose, and mode of administration differs widely across treating physicians. This practice derives from decades of non-randomized, often retrospective data with inconsistent outcomes. The current available tools and risk models are imprecise in their ability to predict which patients are truly at risk of secondary CNS relapse and more recent, large-scale real-world analyses call into question these longstanding practices. In a field lacking any prospective, randomized studies, this review synthesizes the available data investigating the utility of CNS prophylaxis in patients with DLBCL receiving 1st line therapy.

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来源期刊
Blood Reviews
Blood Reviews 医学-血液学
CiteScore
13.80
自引率
1.40%
发文量
78
期刊介绍: Blood Reviews, a highly regarded international journal, serves as a vital information hub, offering comprehensive evaluations of clinical practices and research insights from esteemed experts. Specially commissioned, peer-reviewed articles authored by leading researchers and practitioners ensure extensive global coverage across all sub-specialties of hematology.
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