Wang Huafeng, Wang Ming, Wei Juying, Wang Lei, Mao Liping, Jin Jie
1 Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
2 Institute of Haematology, Zhejiang University, Hangzhou, Zhejiang Province, China.
J Int Med Res. 2018 Feb;46(2):883-894. doi: 10.1177/0300060517734395. Epub 2017 Oct 6.
Objective To retrospectively analyse outcomes in patients with primary central nervous system lymphoma (PCNSL), which is a malignant CNS non-Hodgkin's lymphoma with a poor prognosis. Methods This study retrospectively analysed the treatment and outcomes of patients with PCNSL, which were divided into two groups: surgery (S) group and surgery/biopsy+chemotherapy (SC) group. The latter group was further subdivided into four cohorts based on the treatment regimen: cyclophosphamide, epidoxorubicin, vincristine and prednisone (CHOP), high-dose methotrexate (HDM)+dexamethasone+rituximab (HDM+D+R), HDM+D+temozolomide (HDM+D+T), and HDM+D+R+T. Results The study enrolled 34 patients; 10 of which received surgery only. Between the S and SC groups, the median progression-free survival (PFS) and overall survival (OS) of intracranial PCNSLs ( n = 32) were 8.5 months versus 29 months, respectively; and 8.5 months versus 54 months, respectively (5-year OS: 10.0% versus 48.7%, respectively; 2-year PFS: 0.0% versus 52.6%, respectively). Comparing the CHOP and HDM-based chemotherapy cohorts, the median PFS and OS were 15 months versus not achieved, respectively, and 25 months versus not achieved, respectively (5-year OS: 20.0% versus 60.8%, respectively; 2-year PFS: 20.0% versus 62.7%, respectively). Conclusion Chemotherapy appears to provide a better OS and PFS for patients with PCNSLs compared with surgery alone. HDM+D+T and HDM+D+R+T may be effective choices for PCNSL treatment.
目的 回顾性分析原发性中枢神经系统淋巴瘤(PCNSL)患者的预后情况,PCNSL是一种预后较差的恶性中枢神经系统非霍奇金淋巴瘤。方法 本研究回顾性分析了PCNSL患者的治疗及预后情况,将患者分为两组:手术(S)组和手术/活检+化疗(SC)组。后一组根据治疗方案进一步细分为四个队列:环磷酰胺、表柔比星、长春新碱和泼尼松(CHOP)方案、大剂量甲氨蝶呤(HDM)+地塞米松+利妥昔单抗(HDM+D+R)方案、HDM+D+替莫唑胺(HDM+D+T)方案以及HDM+D+R+T方案。结果 本研究共纳入34例患者;其中10例仅接受了手术治疗。在S组和SC组之间,颅内PCNSL患者(n = 32)的中位无进展生存期(PFS)和总生存期(OS)分别为8.5个月和29个月,以及8.5个月和54个月(5年OS分别为10.0%和48.7%;2年PFS分别为0.0%和52.6%)。比较基于CHOP方案和基于HDM方案化疗队列,中位PFS和OS分别为15个月和未达到,以及25个月和未达到(5年OS分别为20.0%和60.8%;2年PFS分别为20.0%和62.7%)。结论 与单纯手术相比,化疗似乎能为PCNSL患者提供更好的OS和PFS。HDM+D+T和HDM+D+R+T可能是PCNSL治疗有效的选择。