利妥昔单抗、甲氨蝶呤、丙卡巴肼和长春新碱序贯低剂量全脑放疗和阿糖胞苷治疗新诊断的原发性中枢神经系统淋巴瘤：最终结果和长期预后。
Rituximab, methotrexate, procarbazine, and vincristine followed by consolidation reduced-dose whole-brain radiotherapy and cytarabine in newly diagnosed primary CNS lymphoma: final results and long-term outcome.
机构信息
Patrick G. Morris, Denise D. Correa, Joachim Yahalom, Anne S. Reiner, Kathy Panageas, Sasan Karimi, Richard Curry, Gaurav Shah, Lauren E. Abrey, Lisa M. DeAngelis, and Antonio Omuro, Memorial Sloan-Kettering Cancer Center; Rose K. Lai, Columbia University, New York, NY; Jeffrey J. Raizer and Sean Grimm, Northwestern University, Chicago, IL; David Schiff, University of Virginia, Charlottesville, VA; and Barbara Grant, University of Vermont, Burlington, VT.
出版信息
J Clin Oncol. 2013 Nov 1;31(31):3971-9. doi: 10.1200/JCO.2013.50.4910. Epub 2013 Oct 7.
PURPOSE
A multicenter phase II study was conducted to assess the efficacy of rituximab, methotrexate, procarbazine, and vincristine (R-MPV) followed by consolidation reduced-dose whole-brain radiotherapy (rdWBRT) and cytarabine in primary CNS lymphoma.
PATIENTS AND METHODS
Patients received induction chemotherapy with R-MPV (five to seven cycles); those achieving a complete response (CR) received rdWBRT (23.4 Gy), and otherwise, standard WBRT was offered (45 Gy). Consolidation cytarabine was given after the radiotherapy. The primary end point was 2-year progression-free survival (PFS) in patients receiving rdWBRT. Exploratory end points included prospective neuropsychological evaluation, analysis of magnetic resonance imaging (MRI) white matter changes using the Fazekas scale, and evaluation of the apparent diffusion coefficient (ADC) as a prognostic factor.
RESULTS
Fifty-two patients were enrolled, with median age of 60 years (range, 30 to 79 years) and median Karnofsky performance score of 70 (range, 50 to 100). Thirty-one patients (60%) achieved a CR after R-MPV and received rdWBRT. The 2-year PFS for this group was 77%; median PFS was 7.7 years. Median overall survival (OS) was not reached (median follow-up for survivors, 5.9 years); 3-year OS was 87%. The overall (N = 52) median PFS was 3.3 years, and median OS was 6.6 years. Cognitive assessment showed improvement in executive function (P < .01) and verbal memory (P < .05) after chemotherapy, and follow-up scores remained relatively stable across the various domains (n = 12). All examined MRIs (n = 28) displayed a Fazekas score of ≤ 3, and no patient developed scores of 4 to 5; differences in ADC values did not predict response (P = .15), PFS (P = .27), or OS (P = .33).
CONCLUSION
R-MPV combined with consolidation rdWBRT and cytarabine is associated with high response rates, long-term disease control, and minimal neurotoxicity.
目的
进行了一项多中心 II 期研究，以评估利妥昔单抗、甲氨蝶呤、丙卡巴肼和长春新碱（R-MPV）联合巩固性低剂量全脑放疗（rdWBRT）和阿糖胞苷在原发性中枢神经系统淋巴瘤中的疗效。
患者和方法
患者接受 R-MPV 诱导化疗（五至七个周期）；完全缓解（CR）的患者接受 rdWBRT（23.4Gy），否则给予标准 WBRT（45Gy）。放疗后给予巩固性阿糖胞苷。主要终点是接受 rdWBRT 的患者的 2 年无进展生存期（PFS）。探索性终点包括前瞻性神经心理学评估、使用 Fazekas 量表分析磁共振成像（MRI）白质变化、评估表观扩散系数（ADC）作为预后因素。
结果
共纳入 52 例患者，中位年龄 60 岁（范围 30 至 79 岁），Karnofsky 表现评分中位数为 70（范围 50 至 100）。31 例（60%）患者经 R-MPV 治疗后获得 CR 并接受 rdWBRT。该组 2 年 PFS 为 77%；中位 PFS 为 7.7 年。中位总生存期（OS）未达到（中位随访幸存者 5.9 年）；3 年 OS 为 87%。总体（N=52）中位 PFS 为 3.3 年，中位 OS 为 6.6 年。认知评估显示化疗后执行功能（P<.01）和语言记忆（P<.05）有所改善，随访各项评分在各领域均保持相对稳定（n=12）。所有检查的 MRI（n=28）均显示 Fazekas 评分≤3，无患者评分达到 4 至 5；ADC 值的差异不能预测反应（P=.15）、PFS（P=.27）或 OS（P=.33）。
结论
R-MPV 联合巩固性 rdWBRT 和阿糖胞苷治疗与高缓解率、长期疾病控制和最小神经毒性相关。
Zotero 插件