Department of Neuro-Oncology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China.
J Neurooncol. 2013 Oct;115(1):71-7. doi: 10.1007/s11060-013-1196-1. Epub 2013 Jul 5.
There is currently no standard therapy for recurrent or chemotherapy-refractory central nervous system lymphoma (CNSL). Pemetrexed has been reported to have activity in patients with primary CNSL (PCNSL). The use of pemetrexed in secondary CNS lymphoma (SCNSL) has not previously been reported. Here we retrospectively review the outcomes and toxicities of standard and modified doses of pemetrexed as salvage therapy in 18 PCNSL and 12 SCNSL patients. The overall response rate for PCNSL patients was 64.7 %, all of whom achieved a complete response (CR). The median progression-free survival (PFS) was 5.8 months. For the SCNSL patients, RR was 58.3 % with 2 CR (16.7 %); the median PFS was 2.5 months. Grade ≥3 adverse events included leukopenia in 5 patients (16.7 %), neutropenia in 1 patient (3.3 %), and fatigue in 3 patients (10.0 %). 3 patients died while on treatment, 2 due to infections and 1 due to pulmonary embolism. Our results indicate that pemetrexed has activity as salvage therapy in recurrent PCNSL, even with modified dosing, but outcomes trend towards less favorable in SCNSL.
目前，对于复发性或化疗耐药的中枢神经系统淋巴瘤（CNSL）尚无标准治疗方法。培美曲塞已被报道在原发性中枢神经系统淋巴瘤（PCNSL）患者中具有活性。培美曲塞在继发性中枢神经系统淋巴瘤（SCNSL）中的应用以前尚未报道。在这里，我们回顾性地分析了 18 例 PCNSL 和 12 例 SCNSL 患者使用标准剂量和改良剂量的培美曲塞作为挽救性治疗的结果和毒性。PCNSL 患者的总体缓解率（ORR）为 64.7%，所有患者均达到完全缓解（CR）。无进展生存期（PFS）的中位数为 5.8 个月。对于 SCNSL 患者，RR 为 58.3%，其中 2 例达到 CR（16.7%）；中位 PFS 为 2.5 个月。≥3 级不良事件包括 5 例患者（16.7%）出现白细胞减少，1 例患者（3.3%）出现中性粒细胞减少，3 例患者（10.0%）出现疲劳。3 例患者在治疗期间死亡，2 例死于感染，1 例死于肺栓塞。我们的结果表明，培美曲塞作为复发性 PCNSL 的挽救性治疗具有活性，即使采用改良剂量，但其在 SCNSL 中的疗效趋势较差。
