依托泊苷（VP - 16）、异环磷酰胺和阿糖胞苷（Ara - C）对复发性原发性中枢神经系统淋巴瘤患者进行挽救治疗。

Salvage treatment with etoposide (VP-16), ifosfamide and cytarabine (Ara-C) for patients with recurrent primary central nervous system lymphoma.

作者信息

Arellano-Rodrigo Eduardo, López-Guillermo Armando, Bessell Eric M, Nomdedeu Benet, Montserrat Emili, Graus Francesc

机构信息

Service of Hematology, Institut de Recerca Biomèdica August Pi i Sunyer, Hospital Clínic, Barcelona, Spain.

出版信息

Eur J Haematol. 2003 Apr;70(4):219-24. doi: 10.1034/j.1600-0609.2003.00045.x.

DOI:10.1034/j.1600-0609.2003.00045.x

PMID:12656744

Abstract

BACKGROUND

Survival of patients with primary central nervous system lymphoma (PCNSL) has improved with methotrexate-based combination regimens and radiotherapy (RT). However, the prognosis of patients who fail or relapse after initial response is poor. Very little data is available on salvage treatment at recurrence.

PATIENTS AND METHODS

Sixteen immunocompetent patients (13 males/three females, median age 54 yr) with refractory (one patient) or recurrent (15 patients) PCNSL, homogeneously treated at diagnosis with the cyclophosphamide, doxorubicin, vincristine, dexamethasone/carmustine, vincristine, cytarabine and methotrexate (CHOD/BVAM) and RT regimen, received etoposide (VP-16), ifosfamide and cytarabine (Ara-C) (VIA) chemotherapy as a salvage treatment. VIA included etoposide 100 mg/m2/d days 1-3, ifosfamide 1000 mg/m2/d days 1-5, and cytarabine 2000 mg/m2/12 h day 1. The therapy was repeated every 28 d for a total of planned six cycles.

RESULTS

Median time between first complete response (CR) and relapse was 19 months (range: 6-46 months). Thirteen patients (81%) had a performance status <or=2, six had multifocal PCNSL and six (of eight tested) positive cerebrospinal fluid cytology. The median number of courses per patient was four (range: 1-6). Five patients completed the whole VIA therapy. Six patients (37%) achieved CR. After a median follow-up of 15 months for surviving patients, two have relapsed, with a median failure-free survival of 5 months. Twelve patients have died from progression of PCNSL, with a 12-month overall survival of 41% [95% confidence interval (CI): 16-66]. The major toxicity was World Health Organization grade 2-4 neutropenia (69% of patients) and thrombocytopenia (50%). Five patients had grade 3-4 infectious complications. Finally, one patient developed a severe but reversible ifosfamide encephalopathy.

CONCLUSION

The data presented show that the chemotherapy VIA is an effective salvage regimen for patients with recurrent PCNSL.

摘要

背景

基于甲氨蝶呤的联合方案及放疗（RT）已改善了原发性中枢神经系统淋巴瘤（PCNSL）患者的生存率。然而，初始缓解后失败或复发患者的预后较差。关于复发时挽救治疗的数据非常有限。

患者与方法

16例免疫功能正常的难治性（1例）或复发性（15例）PCNSL患者（13例男性/3例女性，中位年龄54岁），诊断时均接受了环磷酰胺、阿霉素、长春新碱、地塞米松/卡莫司汀、长春新碱、阿糖胞苷和甲氨蝶呤（CHOD/BVAM）及RT方案治疗，接受依托泊苷（VP-16）、异环磷酰胺和阿糖胞苷（Ara-C）（VIA）化疗作为挽救治疗。VIA方案包括第1 - 3天依托泊苷100 mg/m²/天，第1 - 5天异环磷酰胺1,000 mg/m²/天，第1天阿糖胞苷2,000 mg/m²/12小时。每28天重复治疗，共计划6个周期。

结果

首次完全缓解（CR）与复发之间的中位时间为19个月（范围：6 - 46个月）。13例患者（81%）体能状态≤2，6例有多灶性PCNSL，6例（8例检测者中）脑脊液细胞学检查呈阳性。每位患者的中位疗程数为4个（范围：1 - 6）。5例患者完成了整个VIA治疗。6例患者（37%）达到CR。存活患者中位随访15个月后，2例复发，无失败生存期的中位数为5个月。12例患者死于PCNSL进展，12个月总生存率为41%[95%置信区间（CI）：16 - 66]。主要毒性为世界卫生组织2 - 4级中性粒细胞减少（69%的患者）和血小板减少（50%）。5例患者出现3 - 4级感染并发症。最后，1例患者发生严重但可逆的异环磷酰胺脑病。