Bojic Marija, Berghoff Anna S, Troch Marlene, Agis Hermine, Sperr Wolfgang R, Widhalm Georg, Wöhrer Adelheid, Kalhs Peter, Preusser Matthias, Rabitsch Werner
Unit for Bone Marrow and Stem Cell Transplantation, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria.
Eur J Haematol. 2015 Jul;95(1):75-82. doi: 10.1111/ejh.12482. Epub 2015 Mar 23.
Primary central nervous system lymphoma (PCNSL) is a rare and malignant tumour type. Established treatment approaches include high-dose methotrexate (HD-MTX)-based chemotherapy and whole-brain radiotherapy (WBRT). WBRT is associated with significant neurotoxicity and autologous haematopoietic stem cell transplantation (ASCT) has been proposed as an alternative treatment - either in the 1st line setting after HD-MTX-based chemotherapy or as salvage treatment for relapsed/refractory PCNSL. We here report our single-centre experience with five PCNSL patients, who had achieved an objective response after a high-dose methotrexate-based induction therapy and consecutively received a high-dose chemotherapy, consisting of carmustine and thiotepa, followed by ASCT. We also provide a literature review on ASCL for PCNSL. Our data, with three of five patients in continuous complete remission and four of five patients alive after a median follow-up time of 8 months, as well as previously published results, show that ASCT is a safe treatment option that is able to induce tumour remissions in patients with PCNSL. However, controlled trials are needed to compare the long-term efficacy and tolerability of ASCT with other treatment approaches and also to establish the optimal sequence of treatment regimens in PCNSL patients.
原发性中枢神经系统淋巴瘤（PCNSL）是一种罕见的恶性肿瘤类型。既定的治疗方法包括以大剂量甲氨蝶呤（HD-MTX）为基础的化疗和全脑放疗（WBRT）。WBRT与显著的神经毒性相关，自体造血干细胞移植（ASCT）已被提议作为一种替代治疗方法——要么在基于HD-MTX的化疗后的一线治疗中使用，要么作为复发/难治性PCNSL的挽救治疗。我们在此报告我们单中心对5例PCNSL患者的经验，这些患者在基于大剂量甲氨蝶呤的诱导治疗后取得了客观缓解，并连续接受了由卡莫司汀和噻替派组成的大剂量化疗，随后进行了ASCT。我们还提供了关于PCNSL的ASCL的文献综述。我们的数据显示，5例患者中有3例持续完全缓解，5例患者中有4例在中位随访时间8个月后仍存活，以及先前发表的结果表明，ASCT是一种安全的治疗选择，能够诱导PCNSL患者的肿瘤缓解。然而，需要进行对照试验来比较ASCT与其他治疗方法的长期疗效和耐受性，并确定PCNSL患者治疗方案的最佳顺序。
