新诊断的原发性中枢神经系统淋巴瘤中使用或不使用利妥昔单抗的大剂量甲氨蝶呤治疗
High-dose methotrexate with or without rituximab in newly diagnosed primary CNS lymphoma.
作者信息
Holdhoff Matthias, Ambady Prakash, Abdelaziz Ahmed, Sarai Guneet, Bonekamp David, Blakeley Jaishri, Grossman Stuart A, Ye Xiaobu
机构信息
From the Brain Cancer Program (M.H., P.A., A.A., G.S., J.B., S.A.G., X.Y.), The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; and Departments of Oncology (M.H., S.A.G.), Radiology (D.B.), Neurology (J.B.), and Neurosurgery (X.Y.), The Johns Hopkins University School of Medicine, Baltimore, MD.
出版信息
Neurology. 2014 Jul 15;83(3):235-9. doi: 10.1212/WNL.0000000000000593. Epub 2014 Jun 13.
OBJECTIVE
To evaluate the efficacy of rituximab (R) when added to high-dose methotrexate (HD-MTX) in patients with newly diagnosed immunocompetent primary CNS lymphomas (PCNSLs).
METHODS
Immunocompetent adults with newly diagnosed PCNSL treated at The Johns Hopkins Hospital between 1995 and 2012 were investigated. From 1995 to 2008, patients received HD-MTX monotherapy (8 g/m2 initially every 2 weeks and after complete response [CR] monthly to complete 12 months of therapy). From 2008 to 2012, patients received the same HD-MTX with rituximab (375 mg/m2) with each HD-MTX treatment. CR rates and median overall and progression-free survival were analyzed for each patient cohort in this single-institution, retrospective study.
RESULTS
A total of 81 patients were identified: 54 received HD-MTX (median age 66 years) while 27 received HD-MTX/R (median age 65 years). CR rates were 36% in the HD-MTX cohort and 73% in the HD-MTX/R cohort (p = 0.0145). Median progression-free survival was 4.5 months in the HD-MTX cohort and 26.7 months in the HD-MTX/R cohort (p = 0.003). Median overall survival was 16.3 months in the HD-MTX cohort and has not yet been reached in the HD-MTX/R cohort (p = 0.01).
CONCLUSIONS
The addition of rituximab to HD-MTX appears to improve CR rates as well as overall and progression-free survival in patients with newly diagnosed PCNSL. Comparisons of long-term survival in the 2 cohorts await further maturation of the data.
CLASSIFICATION OF EVIDENCE
This study provides Class III evidence that in immunocompetent patients with PCNSL, HD-MTX plus rituximab compared with HD-MTX alone improves CR and overall survival rates.
目的
评估利妥昔单抗（R）联合大剂量甲氨蝶呤（HD-MTX）用于新诊断的免疫功能正常的原发性中枢神经系统淋巴瘤（PCNSL）患者的疗效。
方法
对1995年至2012年间在约翰霍普金斯医院接受治疗的新诊断为PCNSL的免疫功能正常的成年人进行调查。1995年至2008年，患者接受HD-MTX单药治疗（初始剂量为8 g/m²，每2周一次，完全缓解[CR]后每月一次，共完成12个月的治疗）。2008年至2012年，患者在每次HD-MTX治疗时接受相同剂量的HD-MTX联合利妥昔单抗（375 mg/m²）。在这项单机构回顾性研究中，分析了每个患者队列的CR率以及中位总生存期和无进展生存期。
结果
共纳入81例患者：54例接受HD-MTX治疗（中位年龄66岁），27例接受HD-MTX/R治疗（中位年龄65岁）。HD-MTX队列的CR率为36%，HD-MTX/R队列的CR率为73%（p = 0.0145）。HD-MTX队列的中位无进展生存期为4.5个月，HD-MTX/R队列的中位无进展生存期为26.7个月（p = 0.003）。HD-MTX队列的中位总生存期为16.3个月，HD-MTX/R队列尚未达到（p = 0.01）。
结论
在新诊断的PCNSL患者中，HD-MTX联合利妥昔单抗似乎可提高CR率以及总生存期和无进展生存期。两个队列长期生存情况的比较有待数据进一步成熟。
证据分类
本研究提供了III类证据，即在免疫功能正常的PCNSL患者中，与单独使用HD-MTX相比，HD-MTX联合利妥昔单抗可提高CR率和总生存率。
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