Abrey Lauren E, Childs Barrett H, Paleologos Nina, Kaminer Lynne, Rosenfeld Steven, Salzman Donna, Finlay Jonathan L, Gardner Sharon, Peterson Kendra, Hu Wendy, Swinnen Lode, Bayer Robert, Forsyth Peter, Stewart Douglas, Smith Anne M, Macdonald David R, Weaver Susan, Ramsay David A, Nimer Stephen D, DeAngelis Lisa M, Cairncross J Gregory
Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Neuro Oncol. 2006 Apr;8(2):183-8. doi: 10.1215/15228517-2005-009. Epub 2006 Mar 8.
We previously reported a phase 2 trial of 69 patients with newly diagnosed anaplastic or aggressive oligodendroglioma who were treated with intensive procarbazine, CCNU (lomustine), and vincristine (PCV) followed by high-dose thiotepa with autologous stem cell rescue. This report summarizes the long-term follow-up of the cohort of 39 patients who received high-dose thiotepa with autologous stem cell support. Thirty-nine patients with a median age of 43 (range, 18-67) and a median KPS of 100 (range, 70-100) were treated. Surviving patients now have a median follow-up of 80.5 months (range, 44-142). The median progression-free survival is 78 months, and median overall survival has not been reached. Eighteen patients (46%) have relapsed. Neither histology nor prior low-grade oligodendroglioma correlated with risk of relapse. Persistent nonenhancing tumor at transplant was identified in our initial report as a significant risk factor for relapse; however, long-term follow-up has not confirmed this finding. Long-term neurotoxicity has developed only in those patients whose disease relapsed and required additional therapy; no patient in continuous remission has developed a delayed neurologic injury. This treatment strategy affords long-term disease control to a subset of patients with newly diagnosed anaplastic oligodendroglioma without evidence of delayed neurotoxicity or myelodysplasia.
我们之前报道了一项针对69例新诊断的间变性或侵袭性少突胶质细胞瘤患者的2期试验，这些患者接受了强化丙卡巴肼、洛莫司汀（CCNU）和长春新碱（PCV）治疗，随后接受高剂量噻替派并进行自体干细胞救援。本报告总结了39例接受高剂量噻替派并获得自体干细胞支持的患者队列的长期随访情况。39例患者接受了治疗，中位年龄为43岁（范围18 - 67岁），中位KPS为100（范围70 - 100）。存活患者目前的中位随访时间为80.5个月（范围44 - 142个月）。中位无进展生存期为78个月，中位总生存期尚未达到。18例患者（46%）复发。组织学类型和既往低级别少突胶质细胞瘤均与复发风险无关。在我们的初始报告中，移植时持续存在的无强化肿瘤被确定为复发的一个重要风险因素；然而，长期随访并未证实这一发现。长期神经毒性仅在疾病复发并需要额外治疗的患者中出现；持续缓解的患者中没有出现延迟性神经损伤。这种治疗策略为一部分新诊断的间变性少突胶质细胞瘤患者提供了长期疾病控制，且无延迟性神经毒性或骨髓发育异常的证据。
