Klinik Innere Medizin I, Saarland University Medical School, Hamburg, Germany;
Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany;
Blood. 2014 Jul 31;124(5):720-8. doi: 10.1182/blood-2013-10-535021. Epub 2014 Jun 17.
To define the role of radiotherapy and intrathecal prophylaxis in extralymphatic craniofacial involvement (ECFI) of aggressive B-cell lymphoma, we analyzed 11 consecutive German High-Grade Non-Hodgkin Lymphoma Study Group trials. ECFI occurred in 290/4155 (7.0%) patients (orbita, 31; paranasal sinuses, 93; main nasal cavity, 38; tongue, 27; remaining oral cavity, 99; salivary glands, 54). In a multivariable analysis adjusted for International Prognostic Index rituximab improved event-free and overall survival both in patients with and without ECFI. Three-year event-free (79% vs 79%; P = .842) and overall survival (86% vs 88%; P = .351) rates were similar in 145 patients receiving and 57 not receiving radiotherapy. Without rituximab, the 2-year cumulative rate of central nervous system (CNS) disease was increased in 205 ECFI patients compared with 2586 non-ECFI patients (4.2% vs 2.8%; P = .038), whereas this was not observed with rituximab (1.6% in 83 ECFI vs 3.4% in 1252 non-ECFI patients; P = .682). In 88 ECFI patients who received intrathecal prophylaxis with methotrexate, the 2-year rate of CNS disease was 4.2% compared with 2.3% in 191 patients who did not (P = .981). In conclusion, rituximab eliminates the increased risk for CNS disease in patients with ECFI. This retrospective analysis does not support intrathecal prophylaxis or radiotherapy to ECFI patients in complete remission/unconfirmed complete remission. These findings should be confirmed in a prospective study.
为了明确放疗和鞘内预防在侵袭性 B 细胞淋巴瘤颅外面部侵犯（ECFI）中的作用，我们分析了 11 项德国高级非霍奇金淋巴瘤研究组的连续试验。11 项研究共纳入 4155 例患者，其中 290 例（7.0%）发生 ECFI（眼眶 31 例，鼻旁窦 93 例，主鼻腔 38 例，舌 27 例，口腔其余部位 99 例，唾液腺 54 例）。多变量分析显示，利妥昔单抗不仅改善了有 ECFI 和无 ECFI 患者的无事件生存和总生存。在接受和未接受放疗的 145 例和 57 例患者中，3 年无事件生存（79% vs 79%；P =.842）和总生存（86% vs 88%；P =.351）率相似。未接受利妥昔单抗治疗的 205 例 ECFI 患者中，2 年累积中枢神经系统（CNS）疾病发生率高于 2586 例非 ECFI 患者（4.2% vs 2.8%；P =.038），而接受利妥昔单抗治疗的患者中未观察到这种情况（83 例 ECFI 患者中为 1.6%，1252 例非 ECFI 患者中为 3.4%；P =.682）。在接受甲氨蝶呤鞘内预防的 88 例 ECFI 患者中，2 年 CNS 疾病发生率为 4.2%，而未接受鞘内预防的 191 例患者为 2.3%（P =.981）。结论：利妥昔单抗可消除 ECFI 患者发生 CNS 疾病的风险增加。本回顾性分析不支持对完全缓解/未确认完全缓解的 ECFI 患者进行鞘内预防或放疗。这些发现需要前瞻性研究进一步证实。
