Colombat Ph, Lemevel A, Bertrand P, Delwail V, Rachieru P, Brion A, Berthou C, Bay J O, Delepine R, Desablens B, Camilleri-Broët S, Linassier C, Lamy T
Hématologie, CHU Tours, Cedex, France.
Bone Marrow Transplant. 2006 Sep;38(6):417-20. doi: 10.1038/sj.bmt.1705452.
The optimum treatment of primary CNS lymphoma (PCNSL) is not yet determined. The objective of this study was to assess the safety and efficacy of initial methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) in patients with newly diagnosed PCNSL. Twenty-five patients received two courses of initial chemotherapy combining methotrexate, etoposide, carmustine and methylprednisolone, and one course of ifosfamide-cytarabine followed by peripheral stem cell collection. Seventeen responsive patients then received HDT using carmustine, etoposide, cytarabine and melphalan with autologous stem cell rescue. After ASCT for responding patients or after salvage therapy for non-responders, whole brain radiation therapy at a dose of 30 Gy was delivered. The objective response rate to the induction chemotherapy was 84%. Four of the 21 responding patients did not have ASCT because of toxicity or refusal. With a median follow-up time of 34 months, the projected event free survival rate is 46% at 4 years. Projected overall survival is 64% at 4 years. Sixteen patients are actually in continuous complete response. No evidence of late treatment-related toxicity was observed. This treatment approach appears feasible in newly diagnosed PCNSL with encouraging results.
原发性中枢神经系统淋巴瘤（PCNSL）的最佳治疗方案尚未确定。本研究的目的是评估以甲氨蝶呤为基础的初始化疗，随后进行高剂量化疗（HDT）联合自体干细胞移植（ASCT）治疗新诊断PCNSL患者的安全性和疗效。25例患者接受了两个疗程的初始化疗，联合使用甲氨蝶呤、依托泊苷、卡莫司汀和甲泼尼龙，以及一个疗程的异环磷酰胺-阿糖胞苷，随后进行外周干细胞采集。17例有反应的患者随后接受了使用卡莫司汀、依托泊苷、阿糖胞苷和马法兰的HDT及自体干细胞解救。对有反应的患者进行ASCT后，或对无反应的患者进行挽救治疗后，给予30 Gy剂量的全脑放射治疗。诱导化疗的客观缓解率为84%。21例有反应的患者中有4例因毒性或拒绝而未进行ASCT。中位随访时间为34个月，预计4年无事件生存率为46%。预计4年总生存率为64%。16例患者实际上处于持续完全缓解状态。未观察到晚期治疗相关毒性的证据。这种治疗方法在新诊断的PCNSL中似乎可行，结果令人鼓舞。
