Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont and Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy.
Leuk Lymphoma. 2013 Sep;54(9):1908-14. doi: 10.3109/10428194.2013.767454. Epub 2013 Feb 20.
Central nervous system (CNS) relapse has not been extensively studied in mantle cell lymphoma (MCL). We retrospectively analyzed the risk factors and pattern of CNS relapse in consecutive patients with MCL. We identified 142 cases of MCL treated from 1980 to 2011. Median age at diagnosis was 68 years; 82% of patients had advanced stage; extranodal disease was reported in 89% of cases and high serum lactate dehydrogenase (LDH) in 40%. Fourteen patients (10%) did not receive treatment at diagnosis. Chemotherapy was administered to 125 patients (88%), in 21 cases (15%) including drugs penetrating into the CNS or given intrathecally; 49 patients (35%) had rituximab. Ten patients had front-line autologous transplant. After a median follow-up of 7.9 years, CNS relapse occurred in 11 cases (7.8%) at a median of 13.8 months. Actuarial risk of CNS relapse was higher in patients with elevated LDH (p = 0.002), higher International Prognostic Index (IPI) score (p = 0.018) and blastoid histology (p < 0.0001). Blastoid histology retained significance at multivariate analysis. Median survival after CNS relapse was 6.3 months. No front-line treatment reduced the risk of CNS relapse. Our analysis confirms the poor outcome of MCL after CNS relapse and may allow the identification of patients needing prophylaxis of CNS relapse.
中枢神经系统（CNS）复发在套细胞淋巴瘤（MCL）中尚未得到广泛研究。我们回顾性分析了连续 MCL 患者 CNS 复发的危险因素和模式。我们确定了 1980 年至 2011 年治疗的 142 例 MCL 病例。诊断时的中位年龄为 68 岁；82%的患者处于晚期；89%的病例存在结外疾病，40%的病例血清乳酸脱氢酶（LDH）升高。14 例患者（10%）在诊断时未接受治疗。125 例患者（88%）接受了化疗，其中 21 例（15%）包括穿透 CNS 的药物或鞘内给药；49 例（35%）接受了利妥昔单抗。10 例患者接受了一线自体移植。中位随访 7.9 年后，11 例（7.8%）患者发生 CNS 复发，中位时间为 13.8 个月。LDH 升高（p = 0.002）、国际预后指数（IPI）评分较高（p = 0.018）和母细胞样组织学（p < 0.0001）的患者 CNS 复发风险更高。母细胞样组织学在多变量分析中仍具有重要意义。CNS 复发后的中位总生存期为 6.3 个月。一线治疗并不能降低 CNS 复发的风险。我们的分析证实了 MCL 患者 CNS 复发后的不良预后，可能有助于识别需要预防 CNS 复发的患者。
