Department of Neuro-Oncology, Erasmus MC Cancer Institute, Brain Tumor Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
Neuro Oncol. 2021 Aug 2;23(8):1315-1326. doi: 10.1093/neuonc/noab021.
To analyze the effect of treatment on neurocognitive functioning and the association of neurocognition with radiological abnormalities in primary central nervous system lymphoma (PCNSL).
One hundred and ninety-nine patients from a phase III trial (HOVON 105/ALLG NHL 24), randomized to standard chemotherapy with or without rituximab, followed in patients ≤60 years old by 30-Gy whole-brain radiotherapy (WBRT), were asked to participate in a neuropsychological evaluation before and during treatment, and up to 2 years posttreatment. Scores were transformed into a standardized z-score; clinically relevant changes were defined as a change in z-score of ≥1 SD. The effect of WBRT was analyzed in irradiated patients. All MRIs were centrally assessed for white matter abnormalities and cerebral atrophy, and their relation with neurocognitive scores over time in each domain was calculated.
125/199 patients consented to neurocognitive evaluation. Statistically significant improvements in neurocognition were seen in all domains. A clinically relevant improvement was seen only in the motor speed domain, without differences between the arms. In the follow-up of irradiated patients (n = 43), no change was observed in any domain score, compared to after WBRT. Small but significant inverse correlations were found between neurocognitive scores over time and changes in white matter abnormalities (regression coefficients: -0.048 to -0.347) and cerebral atrophy (-0.212 to -1.774).
Addition of rituximab to standard treatment in PCNSL patients did not impact neurocognitive functioning up to 2 years posttreatment, nor did treatment with 30-Gy WBRT in patients ≤60 years old. Increased white matter abnormalities and brain atrophy showed weak associations with neurocognition.
分析原发性中枢神经系统淋巴瘤（PCNSL）治疗对神经认知功能的影响，以及神经认知与影像学异常的相关性。
一项 III 期临床试验（HOVON 105/ALLG NHL 24）的 199 例患者，随机分为标准化疗加或不加利妥昔单抗组，年龄≤60 岁的患者在标准治疗的基础上，加用 30Gy 全脑放疗（WBRT），在治疗前、治疗期间和治疗后 2 年内，邀请患者参与神经心理学评估。评分转化为标准化 z 分数；定义临床相关变化为 z 分数变化≥1SD。分析 WBRT 对放疗患者的影响。所有 MRI 均由中心评估白质异常和脑萎缩，并计算每个领域的神经认知评分与时间的关系。
199 例患者中有 125 例同意进行神经认知评估。所有领域的神经认知均有显著改善。只有运动速度领域有临床相关改善，且两组间无差异。在接受放疗的患者（n=43）中，与 WBRT 后相比，任何领域的评分均无变化。随着时间的推移，神经认知评分与白质异常变化（回归系数：-0.048 至-0.347）和脑萎缩（-0.212 至-1.774）之间呈负相关。
利妥昔单抗联合标准治疗方案用于 PCNSL 患者，在治疗后 2 年内对神经认知功能无影响，年龄≤60 岁的患者接受 30Gy WBRT 治疗也无影响。白质异常和脑萎缩增加与神经认知功能弱相关。
