Tomita Naoto, Takasaki Hirotaka, Ishiyama Yasufumi, Kishimoto Kumiko, Ishibashi Daisuke, Koyama Satoshi, Ishii Yoshimi, Takahashi Hiroyuki, Numata Ayumi, Watanabe Reina, Tachibana Takayoshi, Ohshima Rika, Hagihara Maki, Hashimoto Chizuko, Takemura Sachiya, Taguchi Jun, Fujimaki Katsumichi, Sakai Rika, Motomura Shigeki, Ishigatsubo Yoshiaki
Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine , Yokohama , Japan.
Leuk Lymphoma. 2015 Mar;56(3):725-9. doi: 10.3109/10428194.2014.931953. Epub 2014 Aug 6.
This study evaluated the efficacy of central nervous system (CNS) prophylaxis using intrathecal methotrexate (IT-MTX) in patients with diffuse large B-cell lymphoma (DLBCL). We retrospectively studied 322 patients who achieved first complete remission (CR) after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. The CNS prophylaxis consisted of four doses of IT-MTX (15 mg) with hydrocortisone (25 mg) administered after CR was achieved. Forty patients (12%) received CNS prophylaxis (group A) and 282 patients (88%) did not (group B). Three patients in group A (8%) and eight in group B (3%) experienced isolated CNS relapse during the first CR, although this difference was not statistically significant (p = 0.14). Ten of 11 CNS relapses occurred in the brain parenchyma with (n = 3) or without (n = 7) leptomeningeal involvement, and the remaining patient had exclusive leptomeningeal involvement. In patients with DLBCL attaining CR after R-CHOP, IT-MTX administration was insufficient to prevent CNS relapse.
本研究评估了鞘内注射甲氨蝶呤（IT-MTX）用于弥漫性大B细胞淋巴瘤（DLBCL）患者中枢神经系统（CNS）预防的疗效。我们回顾性研究了322例在接受利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）治疗后首次达到完全缓解（CR）的患者。CNS预防措施包括在达到CR后给予四剂IT-MTX（15mg）和氢化可的松（25mg）。40例患者（12%）接受了CNS预防（A组），282例患者（88%）未接受（B组）。A组有3例患者（8%）和B组有8例患者（3%）在首次CR期间发生了孤立性CNS复发，尽管这种差异无统计学意义（p = 0.14）。11例CNS复发中有10例发生在脑实质，伴有（n = 3）或不伴有（n = 7）软脑膜受累，其余1例患者仅有软脑膜受累。在接受R-CHOP治疗后达到CR的DLBCL患者中，给予IT-MTX不足以预防CNS复发。
