Department of Hematology, Kawasaki Medical School, Kurashiki, Japan.
Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Nagaizumi-cho, Japan.
Biol Blood Marrow Transplant. 2019 May;25(5):899-905. doi: 10.1016/j.bbmt.2019.01.020. Epub 2019 Jan 18.
High-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) has been shown to improve the prognosis of patients with central nervous system (CNS) lymphoma. We queried the Japan Society for Hematopoietic Cell Transplantation Registry for 2006 to 2015 to analyze the outcomes of 102 patients with primary CNS lymphoma (PCNSL) who underwent first HDT/ASCT. The median patient age was 54 years (range, 20 to 74 years), and 65 patients were treated in an upfront setting. With a median duration of follow-up of 44 months, the 5-year overall survival (OS) and progession-free survival (PFS) were 54.9% and 38.4%, respectively. There were no significant differences in OS and PFS between upfront and salvage HDT/ASCT. Because thiotepa, a key agent in HDT/ASCT for PCNSL, has been unavailable since 2011 in Japan, the HDT regimens used were not uniform. Thiotepa-containing HDT was received by 16 out of 32 patients before 2010, but by only 2 of 70 patients after 2011. Thiotepa-containing HDT was associated with better PFS (P = .019), lower relapse (P = .042), and a trend toward a survival benefit. In multivariate analysis, noncomplete remission at HDT/ASCT was an independent predictor for OS (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.25 to 4.58; P = .008) and thiotepa-containing HDT remained significant for PFS (HR, .42; 95% CI, .19 to .95; P = .038). These results confirm the activity of thiotepa-containing regimens.
大剂量化疗（HDT）联合自体造血干细胞移植（ASCT）已被证明可改善中枢神经系统（CNS）淋巴瘤患者的预后。我们对日本血液和造血细胞移植学会登记处 2006 年至 2015 年的数据进行了检索，分析了 102 例初治中枢神经系统淋巴瘤（PCNSL）患者接受首次 HDT/ASCT 的结果。患者中位年龄为 54 岁（范围，20 至 74 岁），65 例患者接受了一线治疗。中位随访时间为 44 个月，5 年总生存率（OS）和无进展生存率（PFS）分别为 54.9%和 38.4%。一线与挽救性 HDT/ASCT 的 OS 和 PFS 无显著差异。由于自 2011 年以来，日本已不再使用 PCNSL 中 HDT/ASCT 的关键药物噻替哌，因此 HDT 方案并不统一。2010 年之前，32 例患者中有 16 例接受了含噻替哌的 HDT，但 2011 年之后仅 70 例患者接受了含噻替哌的 HDT。含噻替哌的 HDT 与更好的 PFS（P=0.019）、较低的复发率（P=0.042）以及 OS 获益趋势相关。多因素分析显示，HDT/ASCT 时未达完全缓解是 OS 的独立预测因素（危险比 [HR]，2.40；95%置信区间 [CI]，1.25 至 4.58；P=0.008），含噻替哌的 HDT 对 PFS 仍具有显著意义（HR，0.42；95%CI，0.19 至 0.95；P=0.038）。这些结果证实了含噻替哌方案的疗效。
