Department of Neurology, University of Washington, Seattle, WA, USA.
Medical Scientist Training Program, University of Washington, Seattle, WA, USA.
J Neurooncol. 2021 Jan;151(2):193-200. doi: 10.1007/s11060-020-03648-9. Epub 2021 Jan 4.
Relapsed or refractory primary CNS lymphoma (rrPCNSL) is a rare and challenging malignancy for which better evidence is needed to guide management.
We present a retrospective cohort of 66 consecutive patients with rrPCNSL treated at the University of Washington between 2000 and 2020. Immunosuppressed and secondary CNS lymphoma patients were excluded.
During a median follow-up of 40.5 months from initial diagnosis, median OS for relapsed disease was 14.1 (0.2-88.5) months and median PFS was 11.0 (0.2-73.9) months. At diagnosis (r = 0.85, p < 0.001), first relapse (r = 0.69, p < 0.001), multiple relapses (r = 0.97, p < 0.001) PFS was highly correlated with OS. In contrast, there was no correlation between the duration of subsequent progression-free intervals. No difference in PFS or OS was seen between CSF or intraocular relapse and parenchymal relapse. Patients reinduced with high-dose methotrexate-based (HD-MTX) regimens had an overall response rate (ORR) of 86.7%. Consolidation with autologous stem cell transplant (ASCT) was associated with longer PFS compared to either no consolidation (p = 0.01) and trended to longer PFS when compared to other consolidation strategies (p = 0.06). OS was similarly improved in patients consolidated with ASCT compared with no consolidation (p = 0.04), but not compared with other consolidation (p = 0.22). Although patients receiving ASCT were younger, KPS, sex, and number of recurrences were similar between consolidation groups. A multivariate analysis confirmed an independent effect of consolidation group on PFS (p = 0.01), but not OS.
PFS may be a useful surrogate endpoint which predicts OS in PCNSL. Consolidation with ASCT was associated with improved PFS in rrPCNSL.
复发性或难治性原发性中枢神经系统淋巴瘤（rrPCNSL）是一种罕见且具有挑战性的恶性肿瘤，需要更好的证据来指导治疗。
我们报告了 66 例连续的 rrPCNSL 患者的回顾性队列，这些患者于 2000 年至 2020 年在华盛顿大学接受治疗。排除了免疫抑制和继发性中枢神经系统淋巴瘤患者。
在从初始诊断开始的中位随访 40.5 个月期间，复发疾病的中位总生存期为 14.1（0.2-88.5）个月，中位无进展生存期为 11.0（0.2-73.9）个月。在诊断时（r=0.85，p<0.001）、首次复发时（r=0.69，p<0.001）、多次复发时（r=0.97，p<0.001），无进展生存期与总生存期高度相关。相比之下，随后无进展间隔的持续时间之间没有相关性。CSF 或眼内复发与实质复发之间的无进展生存期或总生存期无差异。用高剂量甲氨蝶呤（HD-MTX）方案诱导缓解的患者总体缓解率（ORR）为 86.7%。与无巩固治疗（p=0.01）相比，自体干细胞移植（ASCT）巩固与更长的无进展生存期相关，与其他巩固策略相比，也有更长的无进展生存期趋势（p=0.06）。与无巩固治疗相比（p=0.04），ASCT 巩固治疗的患者的总生存期也得到了改善，但与其他巩固治疗相比（p=0.22）无差异。尽管接受 ASCT 的患者年龄较小，但在巩固治疗组之间，KPS、性别和复发次数相似。多变量分析证实了巩固治疗组对无进展生存期的独立影响（p=0.01），但对总生存期没有影响。
无进展生存期可能是 PCNSL 的一个有用的替代终点，可以预测总生存期。rrPCNSL 患者行 ASCT 巩固治疗可改善无进展生存期。
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