Omuro Antonio M P, Taillandier Luc, Chinot Olivier, Carnin Charlotte, Barrie Maryline, Hoang-Xuan Khe
AP-HP Hopital Pitie-Salpetriere, Service de Neurologie Mazarin, Universite Paris VI Pierre et Marie Curie, IFR 70, Inserm, Unité U711, Paris, France.
J Neurooncol. 2007 Nov;85(2):207-11. doi: 10.1007/s11060-007-9397-0. Epub 2007 Sep 21.
Treatment for primary CNS lymphoma (PCNSL) in the elderly is associated with lower response rates and higher risks of acute and late delayed toxicity as compared to younger patients. Temozolomide has emerged as a new alternative treatment for PCNSL and constitutes an attractive option for the elderly because of its favorable toxicity profile. In this study we report outcomes of a consecutive series of PCNSL elderly patients initially treated with an innovative regimen combining methotrexate and temozolomide without radiotherapy or intra-thecal chemotherapy.
Histologically confirmed newly-diagnosed PCNSL patients older than 60 years were included. An induction chemotherapy was initially given (methotrexate 3 g /m(2) on days 1, 10, and 20, and temozolomide 100 mg/m(2) on days 1-5). Patients achieving a partial or complete response proceeded to a maintenance phase (up to 5 monthly cycles of methotrexate 3 g/m(2) on day 1, and temozolomide 100 mg/m(2 )days 1-5). Non-responders were treated on an individual basis.
Among the 23 included patients, a complete response was observed in 55%, and disease progressed in the other 45%. Median event-free survival was 8 months, and median overall survival was 35 months. Grades 3 or 4 toxicities included nephrotoxicity in three patients, and hematotoxicity in five; no neurotoxicity has been observed to date. One patient died while on treatment from complications of intestinal obstruction.
Our efficacy results are comparable to other reported regimens, with the advantages of a favorable toxicity profile, and absence of intra-thecal chemotherapy. Prospective, controlled studies are warranted to confirm such results.
与年轻患者相比，老年原发性中枢神经系统淋巴瘤（PCNSL）患者的治疗缓解率较低，急性和迟发性毒性风险较高。替莫唑胺已成为PCNSL的一种新的替代治疗方法，因其良好的毒性特征，对老年人来说是一个有吸引力的选择。在本研究中，我们报告了一系列连续的PCNSL老年患者的治疗结果，这些患者最初接受了一种创新方案治疗，该方案联合使用甲氨蝶呤和替莫唑胺，未进行放疗或鞘内化疗。
纳入组织学确诊的60岁以上新诊断PCNSL患者。最初给予诱导化疗（第1、10和20天给予甲氨蝶呤3 g/m²，第1 - 5天给予替莫唑胺100 mg/m²）。达到部分或完全缓解的患者进入维持阶段（最多5个周期，每月第1天给予甲氨蝶呤3 g/m²，第1 - 5天给予替莫唑胺100 mg/m²）。无反应者进行个体化治疗。
在纳入的23例患者中，55%观察到完全缓解，其他45%疾病进展。无事件生存期的中位数为8个月，总生存期的中位数为35个月。3级或4级毒性包括3例患者出现肾毒性，5例患者出现血液毒性；迄今为止未观察到神经毒性。1例患者在治疗期间因肠梗阻并发症死亡。
我们的疗效结果与其他报道的方案相当，具有毒性特征良好和无需鞘内化疗的优点。有必要进行前瞻性对照研究以证实这些结果。
