Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Division of Hematology and Oncology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Clin Lymphoma Myeloma Leuk. 2019 Oct;19(10):665-669. doi: 10.1016/j.clml.2019.05.012. Epub 2019 May 28.
Optimal management of elderly patients with primary central nervous system lymphoma (PCNSL) after induction therapy is unclear. Whole-brain radiotherapy and autologous stem cell transplantation carry increased toxicity in patients older than 60 years of age, which might outweigh the benefits in this group. Temozolomide (TMZ) has established antineoplastic activity in the central nervous system in other disease states, with a favorable toxicity profile.
We report efficacy and tolerability in a series of 10 patients treated off-label with TMZ maintenance after completion of R-MPV (rituximab, methotrexate, procarbazine and vincristine) treatment for or primary diagnosed PCNSL.
Median progression-free survival (PFS) was 57 months, 2-year PFS was 67%, and 5-year PFS was 33%. Median overall survival (OS) was 63 months, 2-year OS was 88%, and 5-year OS was 57%. TMZ was generally well tolerated, with the most common toxicity of Grade 3 or higher being thrombocytopenia in 3 patients (30%).
These outcomes suggest that TMZ might have activity for maintenance in elderly patients with PCNSL, when more aggressive treatments are contraindicated.
原发性中枢神经系统淋巴瘤（PCNSL）患者在诱导治疗后的最佳治疗方法尚不清楚。全脑放疗和自体干细胞移植在 60 岁以上的患者中具有更高的毒性，这可能超过了该组患者的获益。替莫唑胺（TMZ）在其他疾病状态下已在中枢神经系统中确立了抗肿瘤活性，且具有良好的毒性特征。
我们报告了 10 例患者在完成 R-MPV（利妥昔单抗、甲氨蝶呤、丙卡巴肼和长春新碱）治疗或原发性 PCNSL 诊断后的 TMZ 维持治疗中的疗效和耐受性。
中位无进展生存期（PFS）为 57 个月，2 年 PFS 为 67%，5 年 PFS 为 33%。中位总生存期（OS）为 63 个月，2 年 OS 为 88%，5 年 OS 为 57%。TMZ 通常耐受性良好，最常见的 3 级或更高级别的毒性是血小板减少症，有 3 例（30%）。
这些结果表明，当更具侵袭性的治疗方法禁忌时，TMZ 可能对老年 PCNSL 患者的维持治疗有一定的作用。
