Jahnke Kristoph, Thiel Eckhard, Martus Peter, Schwartz Stefan, Korfel Agnieszka
Department of Hematology, Oncology and Transfusion Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Ann Hematol. 2006 Jan;85(1):45-50. doi: 10.1007/s00277-005-1096-3. Epub 2005 Aug 13.
The aim of this retrospective single-center study was to analyze the clinical characteristics and outcome of non-Hodgkin lymphoma (NHL) patients with central nervous system (CNS) involvement and to identify prognostic factors for survival. We searched our hospital records for NHL patients diagnosed with CNS involvement from 1982 to 2004, and 43 patients were identified. The median age was 63 years (range 23-88) and the median Karnofsky performance status was 55% (range 10-90). Treatment of CNS lymphoma included intrathecal chemotherapy in 33 patients (77%), systemic chemotherapy in 25 (58%), and radiotherapy in 16 (37%). Twenty-six patients showed a CNS response. The median survival after CNS manifestation was 5 months (range 2 days-82.5+months). Nine patients achieved long-term survival. Low lactate dehydrogenase (LDH) at CNS manifestation and a CNS response to therapy were favorable independent prognostic factors for survival in multivariate analysis (p = 0.051 and p < 0.0005, respectively), whereas a young age at initial diagnosis, initial CNS involvement, an initially normal LDH, and high-dose chemotherapy for CNS involvement were significant in univariate analysis. In conclusion, long-term survival can be achieved in patients with secondary CNS lymphoma. LDH at CNS manifestation and a CNS response to therapy were significantly associated with survival.
这项回顾性单中心研究的目的是分析中枢神经系统（CNS）受累的非霍奇金淋巴瘤（NHL）患者的临床特征及预后，并确定生存的预后因素。我们在本院记录中搜索了1982年至2004年期间诊断为CNS受累的NHL患者，共识别出43例患者。中位年龄为63岁（范围23 - 88岁），中位卡氏功能状态评分（KPS）为55%（范围10 - 90）。CNS淋巴瘤的治疗包括33例患者（77%）接受鞘内化疗，25例（58%）接受全身化疗，16例（37%）接受放疗。26例患者出现CNS反应。CNS表现后的中位生存期为5个月（范围2天至82.5 +个月）。9例患者实现长期生存。多因素分析中，CNS表现时低乳酸脱氢酶（LDH）水平及CNS对治疗有反应是生存的有利独立预后因素（分别为p = 0.051和p < 0.0005），而单因素分析中，初始诊断时年龄小、初始CNS受累、初始LDH正常以及针对CNS受累进行大剂量化疗具有显著意义。总之，继发性CNS淋巴瘤患者可实现长期生存。CNS表现时的LDH水平及CNS对治疗的反应与生存显著相关。
