Lymphoid Malignancies Unit.
Lymphoid Malignancies Unit.
Ann Oncol. 2012 May;23(5):1274-1279. doi: 10.1093/annonc/mdr436. Epub 2011 Sep 30.
Central nervous system (CNS) relapse is an uncommon but dramatic complication of diffuse large B-cell lymphoma (DLBCL). Several studies have demonstrated the superiority of cerebrospinal fluid (CSF) flow cytometry (FCM), as compared with conventional cytology (CC), in detecting occult leptomeningeal disease. The clinical relevance of a positive FCM still has to be clarified.
We analyzed CSF from 114 DLBCL patients at diagnosis (n = 95) or at relapse (n = 19) by FCM and CC. Most patients received meningeal prophylaxis. FCM results did not influence treatment strategies.
Fourteen samples were FCM+, versus one CC+ (also FCM+). Within all patients without neurological symptoms (n = 101), four (4%) relapsed in the CNS, with a median time to relapse of 5.2 months. Only one-fourth (25%) was FCM+ before relapse. More than one extranodal disease site and elevated lactate dehydrogenase levels were associated with an increased risk of CNS relapse.
FCM gives far more positive results than CC. However, a positive FCM result did not translate into a significant increase in CNS relapse rate in this histologically uniform population receiving CNS prophylaxis.
中枢神经系统（CNS）复发是弥漫性大 B 细胞淋巴瘤（DLBCL）的一种罕见但严重的并发症。多项研究表明，脑脊液（CSF）流式细胞术（FCM）在检测隐匿性脑膜疾病方面优于传统细胞学（CC）。FCM 阳性的临床相关性仍有待阐明。
我们通过 FCM 和 CC 分析了 114 例 DLBCL 患者在诊断时（n=95）或复发时（n=19）的 CSF。大多数患者接受了脑膜预防。FCM 结果并未影响治疗策略。
14 个样本为 FCM+，而 1 个为 CC+（也是 FCM+）。在所有无神经系统症状的患者（n=101）中，有 4 例（4%）在 CNS 复发，中位复发时间为 5.2 个月。在复发前，仅有四分之一（25%）为 FCM+。存在多个结外疾病部位和乳酸脱氢酶水平升高与 CNS 复发风险增加相关。
FCM 比 CC 产生更多的阳性结果。然而，在接受 CNS 预防的组织学均一人群中，FCM 阳性结果并未显著增加 CNS 复发率。
