Shiota Yuko, Dobashi Nobuaki, Ito Yuta, Hosoba Rika, Yamauchi Hirofumi, Ishii Hiroto, Nakano Aya, Fukushima Ryoko, Ohba Rie, Yahagi Yuichi, Usui Noriko, Yano Shingo
Division of Clinical Oncology/Hematology, The Jikei University Daisan Hospital.
Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine.
Rinsho Ketsueki. 2019;60(2):87-92. doi: 10.11406/rinketsu.60.87.
Primary central nervous system lymphoma (PCNSL) is a rare, aggressive type of non-Hodgkin lymphoma with a poor prognosis and no defined optimal therapeutic strategies. We retrospectively analyzed the survival of six PCNSL patients who were treated with high-dose methotrexate (HDMTX) -based chemotherapy combined with rituximab. The median age at diagnosis was 71 (range, 54-75) years, and the ECOG performance status was ≥3 in four patients. The histopathological findings revealed that all patients had diffuse large B-cell lymphoma. Objective response was obtained in all patients (five, complete response; one, partial response). Three patients had severe non-hematological toxicities: one had pulmonary thromboembolism, one had sepsis, and one developed acute epididymitis. However, each patient recovered and their symptoms could be managed. The median follow-up was 28.8 (range, 13.4-65.5) months. Five patients were still alive and disease-free, and one patient relapsed 62.2 months after the diagnosis. Therefore, the addition of rituximab to HDMTX may improve outcomes. Further clinical investigation is necessary to establish standardized initial therapies for PCNSL, particularly in elderly patients.
原发性中枢神经系统淋巴瘤（PCNSL）是一种罕见的侵袭性非霍奇金淋巴瘤，预后较差，且尚无明确的最佳治疗策略。我们回顾性分析了6例接受以大剂量甲氨蝶呤（HDMTX）为基础的化疗联合利妥昔单抗治疗的PCNSL患者的生存情况。诊断时的中位年龄为71岁（范围54 - 75岁），4例患者的东部肿瘤协作组（ECOG）体能状态≥3。组织病理学检查结果显示，所有患者均为弥漫性大B细胞淋巴瘤。所有患者均获得客观缓解（5例完全缓解；1例部分缓解）。3例患者出现严重的非血液学毒性：1例发生肺血栓栓塞，1例发生败血症，1例发生急性附睾炎。然而，每位患者均康复，其症状得到控制。中位随访时间为28.8个月（范围13.4 - 65.5个月）。5例患者仍存活且无疾病复发，1例患者在诊断后62.2个月复发。因此，在HDMTX基础上加用利妥昔单抗可能改善预后。有必要进行进一步的临床研究，以确立PCNSL的标准化初始治疗方案，尤其是老年患者。
