Department of Hematology, Yamato Municipal Hospital, Yamato, Japan.
Eur J Haematol. 2010 Jul;85(1):6-10. doi: 10.1111/j.1600-0609.2010.01438.x. Epub 2010 Mar 3.
Malignant lymphoma with central nervous system (CNS) involvement has an extremely poor prognosis. We retrospectively studied the risk factors for CNS involvement in patients with diffuse large B-cell lymphoma (DLBCL) treated by cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab (R) -CHOP chemotherapy.
We studied 375 consecutive patients who were newly diagnosed with DLBCL between 1996 and 2006. Patients with primary CNS involvement and patients who received CNS prophylaxis were excluded. All the patients received CHOP (n = 172) or R-CHOP (n = 203) chemotherapy. The following variables were assessed for their potential to predict CNS involvement: gender, age, serum lactate dehydrogenase (LDH) level, performance status, clinical stage, number of extranodal involvements, International Prognostic Index (IPI), bone marrow involvement, presence of a bulky mass, presence of B symptom, and treatment.
CNS involvement was observed in 13 cases (3.5%). In univariate analysis, LDH more than normal range, LDH more than twice as normal range, high IPI, bone marrow involvement, and systemic relapse were the predictors for CNS involvement. In multivariate analysis, no risk factors were detected for CNS involvement. The use of rituximab did not have an impact on CNS involvement.
The incidence of CNS involvement does not decrease in rituximab-era.
伴中枢神经系统（CNS）受累的恶性淋巴瘤预后极差。我们回顾性研究了接受环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP）或利妥昔单抗（R）-CHOP 化疗的弥漫性大 B 细胞淋巴瘤（DLBCL）患者 CNS 受累的危险因素。
我们研究了 1996 年至 2006 年间新诊断为 DLBCL 的 375 例连续患者。排除了原发性 CNS 受累和接受 CNS 预防的患者。所有患者均接受 CHOP（n=172）或 R-CHOP（n=203）化疗。评估了以下变量对 CNS 受累的潜在预测能力：性别、年龄、血清乳酸脱氢酶（LDH）水平、体能状态、临床分期、结外受累部位数、国际预后指数（IPI）、骨髓受累、大肿块、B 症状和治疗。
13 例（3.5%）出现 CNS 受累。单因素分析显示，LDH 高于正常范围、LDH 高于正常范围两倍以上、高 IPI、骨髓受累和全身复发是 CNS 受累的预测因素。多因素分析未发现 CNS 受累的危险因素。利妥昔单抗的使用并未影响 CNS 受累。
在利妥昔单抗时代，CNS 受累的发生率并未降低。
