中枢神经系统血管内淋巴瘤：治疗选择
Intravascular Lymphoma in the CNS: Options for Treatment.
作者信息
Nizamutdinov Damir, Patel Nitesh P, Huang Jason H, Fonkem Ekokobe
机构信息
College of Medicine, Texas A&M Health Science Center, Temple, TX, USA.
Department of Neurosurgery, Baylor Scott & White Health, Temple, TX, USA.
出版信息
Curr Treat Options Neurol. 2017 Aug 23;19(10):35. doi: 10.1007/s11940-017-0471-4.
Abstract
Purpose of review The purpose of this review was to discuss therapeutic manipulations and effective current interventions available to treat intravascular lymphoma in the central nervous system. Recent findings Patients experienced resolution and remission of disease for 14 months and up to 2 years after eight cycles of R-CHOP and four courses of intrathecal therapy with MTX, cytarabine, and prednisolone. Intravascular use of unfractionated heparin during therapy may contribute to better outcome. Summary Series of therapeutic avenues were analyzed and compared. The effective current treatment of intravascular lymphoma in the CNS is considered to be a combinational intrathecal methotrexate-based chemotherapy with rituximab. Since intrathecal administration bypasses the blood-brain barrier, lower doses can be given, which thereby minimizes systemic toxicity. Practical use of intrathecal chemotherapy is also justified for prophylaxis in intravascular lymphoma-diagnosed patients without CNS involvement.
摘要
综述目的 本综述旨在探讨治疗中枢神经系统血管内淋巴瘤的治疗手段及当前有效的干预措施。 最新发现 患者在接受8个周期的R-CHOP方案化疗及4个疗程的鞘内注射甲氨蝶呤、阿糖胞苷和泼尼松龙治疗后，疾病缓解达14个月至2年。治疗期间血管内使用普通肝素可能有助于取得更好的疗效。 总结 分析并比较了一系列治疗途径。目前认为，中枢神经系统血管内淋巴瘤的有效治疗方法是基于甲氨蝶呤的鞘内联合化疗及利妥昔单抗治疗。由于鞘内给药绕过了血脑屏障，因此可以给予较低剂量，从而将全身毒性降至最低。对于已诊断为血管内淋巴瘤但无中枢神经系统受累的患者，鞘内化疗的预防性应用也是合理的。
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