弥漫性大B细胞淋巴瘤的中枢神经系统复发：单中心经验
CNS relapse of diffuse large B cell Lymphoma A single centre experience.
作者信息
Nazir Adil, Siddique Neelam, Hameed Abdul
机构信息
Dr. Adil Nazir, MBBS, FCPS (Medicine). Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan.
Dr. Fawad, MBBS, FCPS (Medicine). Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan.
出版信息
Pak J Med Sci. 2017 Nov-Dec;33(6):1454-1458. doi: 10.12669/pjms.336.13812.
BACKGROUND AND OBJECTIVE
Central nervous system (CNS) relapse of diffuse large B cell lymphoma (DLBCL) is relatively uncommon and nearly fatal. Two years CNS relapse risk is 0.8% in low, 3.9% in intermediate and 12% in high risk patients. Our aim was to study, the baseline characteristics and outcome in term of median survival of DLBCL patients with CNS relapse.
METHODS
This is a retrospective analysis. All patients of DLBCL with CNS relapse from 2006 to 2014 were included. Data were collected from computerized Hospital Information System and analyzed for characteristics and median survival.
RESULTS
Out of twenty one patients included in the study, 14(66.3%) males and 7(33.7%) were females. On initial diagnosis of DLBCL, median age was 37.4 years (27-47). Ann Arbor stage of I-IV was in 3 (14.3%), 2(9.5%), 4(19%) and 12(57.1%) patients, respectively. Extra-nodal involvement was noted in 16(76.2%), high LDH in 18(85.7%), bone marrow involvement in 8(38.1%) and bulky disease in 5(23.8%) patients. International Prognostic Index (IPI) score was 1 in 4(19%), 2 in 9(42.9%), 3 in 8(38.1%) patients. Extra-nodal sites were gut in 2(9.1%) while 1(4.5%) patient of each of following organs involvement was seen: cervix, gluteal muscle, iliac bone, liver, ovaries, pancreas, parotid gland and testes. Chemotherapy CHOP was given to 16(76.2%) and RCHOP in 5(23.8%) patients. Prophylactic intrathecal methotrexate was given to 10(47.6%) patients. Complete response was in 10 (47.6%), partial response was in 3 (14.3%) and disease progression was in 8 (38.1%) patients. CNS relapse occurred in 17 (81%) patients within six months after completion of therapy. CNS relapse along with systemic disease was in 14(66.6%) patients. Isolated CNS relapse was noted in 7(33.3%) patients. Second line chemotherapy regimens were HDMTX 5(23.8%), HDMTX/TRIO IT 3(14.2%), HDMTX/HDAC 2(9.5%), HCVAD 3(14.2%), ICE 4(19.4%), DHAP 1(4.7%), ICE/HDMTX 1(4.7%), none 2(9.5%). Overall median survival of CNS relapsed patients was 54 days.
CONCLUSION
Patients with DLBCL who had advanced stage, high LDH and extra-nodal involvement at initial presentation are at high risk for CNS relapse. About half of the patients had CNS relapse despite primary CNS prophylaxis. Once relapsed in CNS, these patients have very poor prognosis.
背景与目的
弥漫性大B细胞淋巴瘤（DLBCL）的中枢神经系统（CNS）复发相对少见且近乎致命。低危、中危和高危患者的两年CNS复发风险分别为0.8%、3.9%和12%。我们的目的是研究DLBCL中枢神经系统复发患者的基线特征及以中位生存期衡量的预后情况。
方法
这是一项回顾性分析。纳入了2006年至2014年所有发生CNS复发的DLBCL患者。数据从计算机化的医院信息系统收集，并对特征和中位生存期进行分析。
结果
纳入研究的21例患者中，男性14例（66.3%），女性7例（33.7%）。初诊DLBCL时，中位年龄为37.4岁（27 - 47岁）。Ann Arbor分期为I - IV期的患者分别有3例（14.3%）、2例（9.5%）、4例（19%）和12例（57.1%）。16例（76.2%）患者有结外受累，18例（85.7%）患者乳酸脱氢酶升高，8例（38.1%）患者有骨髓受累，5例（23.8%）患者有大包块病变。国际预后指数（IPI）评分1分的患者有4例（19%），2分的有9例（42.9%），3分的有8例（38.1%）。结外部位受累的患者中，2例（9.1%）累及肠道，以下各器官受累的患者各有1例（4.5%）：宫颈、臀肌、髂骨、肝脏、卵巢、胰腺、腮腺和睾丸。16例（76.2%）患者接受了CHOP化疗，5例（23.8%）患者接受了RCHOP化疗。10例（47.6%）患者接受了预防性鞘内注射甲氨蝶呤。完全缓解的患者有10例（47.6%），部分缓解的有3例（14.3%），疾病进展的有8例（38.1%）。17例（81%）患者在治疗结束后6个月内发生CNS复发。14例（66.6%）患者CNS复发伴全身疾病。7例（33.3%）患者为孤立性CNS复发。二线化疗方案包括大剂量甲氨蝶呤（HDMTX）5例（23.8%）、HDMTX/TRIO鞘内注射3例（14.2%）、HDMTX/HDAC 2例（9.5%）、HCVAD 3例（14.2%）、ICE 4例（19.4%）、DHAP 1例（4.7%）、ICE/HDMTX 1例（4.7%）、未治疗2例（9.5%）。CNS复发患者的总体中位生存期为54天。
结论
初诊时处于晚期、乳酸脱氢酶升高且有结外受累的DLBCL患者发生CNS复发的风险较高。尽管进行了原发性CNS预防，仍约有一半的患者发生CNS复发。一旦CNS复发，这些患者的预后非常差。
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