目的:原发性中枢神经系统淋巴瘤(PCNSL)是一种局限在中枢神经系统的侵袭性肿瘤。尽管提供大剂量甲氨蝶呤(HD-MTX)可显著改善PCNSL患者的预后,诱导治疗的最佳治疗方案和标准MTX剂量在很大程度上存在争议.在这里,我们试图探讨辅助利妥昔单抗和不同剂量诱导HD-MTX对免疫功能正常的PCNSL患者生存结局的影响.
方法:在本研究中,我们对在NCI指定的综合性癌症中心接受PCNSL治疗的患者进行了检查,以评估他们的生存结局.我们对2001年至2019年在阿拉巴马大学伯明翰分校(UAB)接受诱导化疗的51例PCNSL免疫功能正常患者进行了回顾性分析。仅包括确诊为PCNSL的成年患者,这些患者单独使用HD-MTX或与利妥昔单抗联合使用。患者人口统计学,临床特征,收集和分析生存数据。
结果:单独接受MTX与MTX加利妥昔单抗的患者的生存率没有显着差异(HR=0.996(95%CI:0.398-2.493),p=0.994)。较低剂量的MTX与较差的生存结果相关(HR=0.680(95%CI:0.530-0.872),p=0.002);然而,当调整到年龄时,生存率的差异并不显著(HR=0.797(95%CI:0.584-1.088),p=0.153)。
结论:我们的经验挑战利妥昔单抗在PCNSL诱导治疗中的作用。我们的研究还强调了老年PCNSL患者的生存期较短,在某种程度上,相对较低剂量的HD-MTX。通过前瞻性研究,对PCNSL中最有效的前期方案达成共识的需求尚未得到满足。
OBJECTIVE: Primary Central Nervous System Lymphoma (PCNSL) is an aggressive tumor that is confined to the CNS. Although the provision of high-dose methotrexate (HD-MTX) has remarkably improved outcomes in PCNSL patients, the optimal treatment regimens and standard MTX dose for induction therapy have been largely controversial. Herein, we sought to explore the impact of adjuvant rituximab and different dosages of induction HD-MTX on survival outcomes of immunocompetent patients with PCNSL.
METHODS: In this
study, we examined patients with PCNSL treated at a single NCI-designated comprehensive cancer center to evaluate their survival outcomes. We conducted a retrospective analysis of 51 immunocompetent patients with PCNSL who received their induction chemotherapy at the University of Alabama at Birmingham (UAB) between 2001 and 2019. Only adult patients with a confirmed diagnosis of PCNSL who had either HD-MTX alone or in combination with rituximab were included. Patients\' demographics, clinical characteristics, and survival data were collected and analyzed.
RESULTS: There is no significant difference in survival among patients who received MTX alone versus MTX plus rituximab (HR = 0.996 (95% CI: 0.398-2.493), p = 0.994). Lower doses of MTX were associated with worse survival outcomes (HR = 0.680 (95% CI: 0.530-0.872), p = 0.002); however, this difference in survival was not significant when adjusted to age (HR = 0.797 (95% CI: 0.584-1.088), p = 0.153).
CONCLUSIONS: Our experience challenges the role of rituximab in PCNSL during induction therapy. Our
study also highlights the shorter survival in elderly patients with PCNSL which can be related, to some extent, to the relatively lower doses of HD-MTX. There is an unmet need to establish a consensus on the most effective upfront regimen in PCNSL through prospective studies.