Jalaeikhoo Hasan, Yekaninejad Mir Saeed, Hajizamani Saeideh, Rahim Fakher, Ahmadzadeh Ahmad, Keyhani Manoutchehr, Sadeghi Hariri Behrooz, Saki Najmaldin
AJA Cancer Research Center (ACRC), AJA University of Medical Sciences, Tehran, Iran.
Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Science, Tehran, Iran.
Arch Iran Med. 2015 Sep;18(9):577-81.
We assessed the outcome of high-dose methotrexate (HD-MTX) chemotherapy with or without radiotherapy (RT) in primary central nervous system lymphoma (PCNSL) patients.
Fifty-one HIV-negative patients with an average age of 50.3 years were treated with chemotherapy regimen included 2500 mg/m(2) MTX with Leucovorin rescue and 1.4 mg/m(2) vincristine (day two), which was administered every other week for 6 weeks. Only the patients who were younger than 60 years received RT. All patients received two cycles of 3000 mg/m(2) cytarabine at the end of the treatment for two successive days.
Diffuse large B-cell lymphoma was the most common histologic subtype (90.2%), and twenty-six (51.0%)patients had multiple brain lesions. The median survival of patients who were younger than 60 years was 37 months. For patients who were older than 60 years, the median survival was 20 months. The median survival of men and women were 30 and 34 months, respectively. There was no significant difference in survival of patients in terms of age and sex. Overall, sixteen patients (31%) out of fifty-one patients died, five of them were older than 60 years and eleven were younger than 60 years. Twenty-five (49%) of all patients experienced relapse, and 10 (40%) of them died after rechemotherapy.
The base of our chemotherapy regimen was HD-MTX as the regular doses of MTX cannot penetrate the blood brain barrier (BBB). Our results indicated that the combination of HD-MTX with RT may not influence the outcome of PCNSL; thus, RT cannot be the first line therapy.
我们评估了大剂量甲氨蝶呤（HD-MTX）化疗联合或不联合放疗（RT）用于原发性中枢神经系统淋巴瘤（PCNSL）患者的疗效。
51例平均年龄为50.3岁的HIV阴性患者接受化疗方案，包括2500mg/m²甲氨蝶呤并进行亚叶酸钙解救，以及1.4mg/m²长春新碱（第2天），每两周给药1次，共6周。仅年龄小于60岁的患者接受放疗。所有患者在治疗结束时连续两天接受两个周期的3000mg/m²阿糖胞苷治疗。
弥漫性大B细胞淋巴瘤是最常见的组织学亚型（90.2%），26例（51.0%）患者有多处脑病变。年龄小于60岁患者的中位生存期为37个月。年龄大于60岁的患者，中位生存期为20个月。男性和女性的中位生存期分别为30个月和34个月。患者的生存期在年龄和性别方面无显著差异。总体而言，51例患者中有16例（31%）死亡，其中5例年龄大于60岁，11例年龄小于60岁。所有患者中有25例（49%）复发，其中10例（40%）在再次化疗后死亡。
我们化疗方案的基础是HD-MTX，因为常规剂量的甲氨蝶呤无法穿透血脑屏障（BBB）。我们的结果表明，HD-MTX与放疗联合可能不会影响PCNSL的疗效；因此，放疗不能作为一线治疗。
