采用噻替派、白消安和环磷酰胺预处理方案的大剂量化疗和自体造血干细胞移植治疗原发性和继发性中枢神经系统淋巴瘤的持久生存结果。
Durable Survival Outcomes in Primary and Secondary Central Nervous System Lymphoma After High-dose Chemotherapy and Autologous Stem Cell Transplantation Using a Thiotepa, Busulfan, and Cyclophosphamide Conditioning Regimen.
机构信息
Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
出版信息
Clin Lymphoma Myeloma Leuk. 2020 Jul;20(7):468-479. doi: 10.1016/j.clml.2020.02.009. Epub 2020 Feb 20.
BACKGROUND
High-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) has been investigated in patients with primary central nervous system lymphoma (PCNSL) and non-Hodgkin lymphoma (NHL) with CNS involvement and has shown promising results.
PATIENTS AND METHODS
A retrospective analysis was performed of 48 consecutive patients who had undergone HDC/ASCT with TBC (thiotepa, busulfan, cyclophosphamide) conditioning for PCNSL (27 patients), secondary CNS lymphoma (SCNSL) (8 patients), or relapsed disease with CNS involvement (13 patients) from July 2006 to December 2017. Of the 27 patients with PCNSL, 21 had undergone ASCT at first complete remission (CR1).
RESULTS
The 2-year progression-free survival (PFS) rate was 80.5% (95% confidence interval [CI], 69.9-92.9) and the 2-year overall survival (OS) rate was 80.1% (95% CI, 69.2%-92.7%) among all patients. The 2-year PFS and OS rate for patients with PCNSL in CR1 was 95.2% (95% CI, 86.6%-100%) and 95.2% (95% CI, 86.6%-100%), respectively. On univariate analysis of the patients with PCNSL, ASCT in CR1 was the only variable statistically significant for outcome (P = .007 for PFS; P = .008 for OS). Among patients with SCNSL or CNS relapse, the 2-year PFS and OS rate were comparable at 75.9% (95% CI, 59.5%-96.8%) and 75.3% (95% CI, 58.6%-98.6%), respectively. The most common side effects were febrile neutropenia (89.6%; of which 66.7% had an infectious etiology identified), nausea/vomiting (85.4%), diarrhea (93.8%), mucositis (89.6%), and electrolyte abnormalities (89.6%). Four patients (8.3%) died of treatment-related overwhelming infection; of these patients, 3 had SCNSL.
CONCLUSION
HDC and ASCT using TBC conditioning for both PCNSL and secondary CNS NHL appears to have encouraging long-term efficacy with manageable side effects.
背景
高剂量化疗（HDC）联合自体干细胞移植（ASCT）已在原发性中枢神经系统淋巴瘤（PCNSL）和伴有中枢神经系统受累的非霍奇金淋巴瘤（NHL）患者中进行了研究，结果显示出良好的前景。
方法
对 2006 年 7 月至 2017 年 12 月期间接受 TBC（噻替哌、白消安、环磷酰胺）预处理的 48 例连续 PCNSL（27 例）、继发性中枢神经系统淋巴瘤（SCNSL）（8 例）或伴有中枢神经系统受累的复发性疾病（13 例）患者进行了回顾性分析。27 例 PCNSL 患者中，21 例在首次完全缓解（CR1）时接受了 ASCT。
结果
所有患者的 2 年无进展生存率（PFS）为 80.5%（95%可信区间[CI]，69.9%-92.9%），2 年总生存率（OS）为 80.1%（95%CI，69.2%-92.7%）。CR1 时 PCNSL 患者的 2 年 PFS 和 OS 率分别为 95.2%（95%CI，86.6%-100%）和 95.2%（95%CI，86.6%-100%）。单因素分析显示，CR1 时接受 ASCT 是影响结局的唯一统计学显著变量（PFS 为 P=0.007；OS 为 P=0.008）。SCNSL 或 CNS 复发患者的 2 年 PFS 和 OS 率分别为 75.9%（95%CI，59.5%-96.8%）和 75.3%（95%CI，58.6%-98.6%），两者相似。最常见的不良反应为发热性中性粒细胞减少症（89.6%；其中 66.7%有感染病因）、恶心/呕吐（85.4%）、腹泻（93.8%）、黏膜炎（89.6%）和电解质异常（89.6%）。4 例（8.3%）患者因治疗相关的严重感染而死亡；其中 3 例为 SCNSL 患者。
结论
对于 PCNSL 和继发性中枢神经系统 NHL，采用 TBC 预处理的 HDC 和 ASCT 似乎具有令人鼓舞的长期疗效，且不良反应可管理。
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