Seidel Sabine, Kowalski Thomas, Margold Michelle, Baraniskin Alexander, Schroers Roland, Martus Peter, Schlegel Uwe
Department of Neurology, Knappschaftskrankenhaus, University Hospital Bochum, In der Schornau 23-25, Bochum, 44892, Germany.
Department of Neurology, Knappschaftskrankenhaus, University of Bochum, Bochum, Germany.
Ther Adv Neurol Disord. 2020 Oct 7;13:1756286420951087. doi: 10.1177/1756286420951087. eCollection 2020.
To investigate outcome and toxicity of high-dose systemic methotrexate (HDMTX)-based polychemotherapy and intracerebroventricular (ICV) chemotherapy an Ommaya reservoir in elderly patients with primary central nervous system lymphoma (PCNSL).
We performed a retrospective analysis on patients ⩾65 years with first diagnosis of PCNSL admitted to our center between January 2015 and December 2019. These patients were treated with a standardized chemotherapy protocol in case of absent contraindications for HDMTX-based chemotherapy. The protocol contained induction therapy with systemic rituximab, methotrexate and ifosfamide and consolidation treatment with systemic cytarabine (AraC) and ICV methotrexate, prednisolone and AraC.
Of a total of 46 patients seen in this period, 3 did not qualify for HDMTX. Thus, 43 patients were included in this analysis. Median age was 74 years (range 65-86), median Karnofsky performance score was 50 (range 20-90). Of the 43 patients, 32 (74.4%) completed treatment including ICV therapy. Complete remission/complete remission unconfirmed was achieved in 26 of 43 patients (60.5%), partial response (PR) in 3 (7%); 5 (11.6%) had progressive disease, and 3 (7.0%) died due to treatment-related complications; in the remaining 6 (14.0%) therapy could not be completed. Median progression free survival was 16 months (95% confidence interval 8-24 months) and median overall survival had not been reached after a median follow up of 23 months (range 1-52 months); the 75th percentile survival time was 12 months. No Ommaya reservoir infection was observed. Complications of ICV treatment were pericatheter leucencephalopathy in two patients and surgical scar dehiscence with cerebrospinal fluid leak in one patient.
Toxicity of HDMTX plus ICV chemotherapy for elderly patients with PCNSL was manageable and outcome was excellent for patients treated with this protocol.
探讨以大剂量全身甲氨蝶呤（HDMTX）为基础的多药化疗联合脑室内（ICV）化疗及使用奥马亚贮液器治疗老年原发性中枢神经系统淋巴瘤（PCNSL）患者的疗效和毒性。
我们对2015年1月至2019年12月期间首次诊断为PCNSL并入住我院中心的65岁及以上患者进行了回顾性分析。对于无HDMTX化疗禁忌证的患者，采用标准化化疗方案进行治疗。该方案包括全身使用利妥昔单抗、甲氨蝶呤和异环磷酰胺进行诱导治疗，以及全身使用阿糖胞苷（AraC）和脑室内使用甲氨蝶呤、泼尼松龙和阿糖胞苷进行巩固治疗。
在此期间共诊治46例患者，其中3例不符合HDMTX治疗条件。因此，本分析纳入43例患者。中位年龄为74岁（范围65 - 86岁），中位卡诺夫斯基表现评分50分（范围20 - 90分）。43例患者中，32例（74.4%）完成了包括脑室内治疗在内的治疗。43例患者中有26例（60.5%）达到完全缓解/未确认的完全缓解，3例（7%）部分缓解（PR）；5例（11.6%）疾病进展，3例（7.0%）因治疗相关并发症死亡；其余6例（14.0%）未完成治疗。中位无进展生存期为16个月（95%置信区间8 - 24个月），中位随访23个月（范围1 - 52个月）后中位总生存期未达到；第75百分位数生存时间为12个月。未观察到奥马亚贮液器感染。脑室内治疗的并发症为2例患者发生导管周围白质脑病，1例患者手术切口裂开伴脑脊液漏。
HDMTX联合ICV化疗治疗老年PCNSL患者的毒性是可控的，采用该方案治疗的患者疗效良好。
