Kanemasa Yusuke, Shimoyama Tatsu, Sasaki Yuki, Tamura Miho, Sawada Takeshi, Omuro Yasushi, Hishima Tsunekazu, Maeda Yoshiharu
Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan.
Department of Clinical Research Support, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Ann Hematol. 2016 Oct;95(10):1661-9. doi: 10.1007/s00277-016-2744-5. Epub 2016 Jul 2.
Central nervous system (CNS) relapse in patients with diffuse large B cell lymphoma (DLBCL) is an uncommon event, and the outcome of patients with CNS relapse is poor. However, no reliable prediction models for CNS relapse have been developed. We retrospectively analyzed consecutive de novo DLBCL patients referred to our department between September 2004 and August 2015 and treated with R-CHOP or R-CHOP-like regimens. Of 413 patients analyzed in this study, a total of 27 patients (6.5 %) eventually developed CNS relapse. The 5-year probability of CNS relapse was 8.4 %. The median time from diagnosis of DLBCL to CNS relapse was 15 months, and the median survival after CNS relapse was 7 months. In univariate analysis, the risk factors significantly associated with CNS relapse were Ann Arbor stage 3 or 4, albumin level <3.2 mg/L, number of extranodal sites >1, and involvement of retroperitoneal lymph node. We developed a new prognostic model consisting of these four factors. The 5-year probability of CNS relapse was significantly higher in patients with at least three of these four factors than in those with two or fewer factors (26.4 vs. 3.0 %, P < 0.001). Using this model, we evaluated the incidence and the risk factors of CNS relapse in DLBCL patients. The new risk model consisting of the four factors demonstrated good risk stratification for CNS relapse, and could help to identify high-risk patients for whom CNS prophylaxis is warranted.
弥漫性大B细胞淋巴瘤（DLBCL）患者发生中枢神经系统（CNS）复发是一种罕见事件，且CNS复发患者的预后较差。然而，尚未建立可靠的CNS复发预测模型。我们回顾性分析了2004年9月至2015年8月间转诊至我科并接受R-CHOP或类似R-CHOP方案治疗的初治DLBCL患者。在本研究分析的413例患者中，共有27例（6.5%）最终发生CNS复发。CNS复发的5年概率为8.4%。从DLBCL诊断到CNS复发的中位时间为15个月，CNS复发后的中位生存期为7个月。单因素分析显示，与CNS复发显著相关的危险因素为Ann Arbor分期3或4期、白蛋白水平<3.2 mg/L、结外部位数量>1个以及腹膜后淋巴结受累。我们建立了一个由这四个因素组成的新预后模型。具有这四个因素中至少三个因素的患者CNS复发的5年概率显著高于具有两个或更少因素的患者（26.4%对3.0%，P<0.001）。使用该模型，我们评估了DLBCL患者CNS复发的发生率和危险因素。由这四个因素组成的新风险模型对CNS复发显示出良好的风险分层，有助于识别需要进行CNS预防的高危患者。
