Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
Molecular Neuroncology Unit Fondazione IRCSS Istituto Neurologico Carlo Besta, Milan, Italy.
J Neurol. 2021 Aug;268(8):2866-2875. doi: 10.1007/s00415-021-10438-4. Epub 2021 Feb 20.
Malignant gliomas (MG) are aggressive brain tumours in adults. The standard of care is concurrent radiation plus temozolomide (TMZ) [chemo-radiotherapy (CRT)] followed by TMZ maintenance up to 6 months. TMZ is considered to have a low toxicity profile, but several studies reported occurrence of severe myelosuppression, especially during the concomitant phase. Toxicity may be prolonged, thus treatment should be discontinued.
To evaluate the risk of recurrente myelotoxicity during adjuvant chemotherapy (CT) in patients who recovered from severe myelotoxicity during CRT.
We retrospectively collected data on patients with MG who developed and recovered from severe myelotoxicity during CRT from eight Italian neuro-oncology centers.
We included 87 patients. Histology was Glioblastoma (GBM) in 78 patients (89.7%); 60% of patients were female. After myelotoxicity recovery, 54 (62%) received treatment. The majority of them (82%, n = 44) received adjuvant TMZ and 18% (n = 10) others treatments. Out of 44 patients who received adjuvant TMZ, 34% experienced the re-occurrence of grade 3-4 myelotoxicity which required permanent CT discontinuation in 6 (13%) cases. Patients who received TMZ or other treatments had longer overall (OS) (adjusted HR 0.46, p = 0.008) and progression free survival (PFS) (adjusted HR 0.57, p = 0.034) than those who remained untreated.
Our study suggests that after severe myelotoxicity the majority of patients received treatment, particularly with TMZ. Only a fraction of patients experienced toxicity recurrence, suggesting that TMZ is well tolerated and had an impact on PFS and OS.
恶性胶质瘤（MG）是成人中侵袭性脑肿瘤。标准治疗是同时进行放疗加替莫唑胺（TMZ）[放化疗（CRT）]，然后进行 TMZ 维持治疗长达 6 个月。TMZ 被认为具有低毒性特征，但几项研究报告了严重骨髓抑制的发生，特别是在同时期。毒性可能会延长，因此应停止治疗。
评估在 CRT 期间发生严重骨髓抑制并从中恢复的患者在辅助化疗（CT）期间发生复发性骨髓毒性的风险。
我们从 8 个意大利神经肿瘤学中心回顾性收集了在 CRT 期间发生并从中恢复严重骨髓抑制的 MG 患者的数据。
我们纳入了 87 名患者。78 名患者（89.7%）的组织学为胶质母细胞瘤（GBM）；60%的患者为女性。在骨髓抑制恢复后，有 54 名（62%）接受了治疗。其中大多数（82%，n=44）接受了辅助 TMZ 治疗，18%（n=10）接受了其他治疗。在接受辅助 TMZ 治疗的 44 名患者中，34%出现了 3-4 级骨髓毒性的再次发生，其中 6 例（13%）需要永久停止 CT 治疗。接受 TMZ 或其他治疗的患者总生存期（OS）（调整后的 HR 0.46，p=0.008）和无进展生存期（PFS）（调整后的 HR 0.57，p=0.034）更长。
我们的研究表明，在发生严重骨髓抑制后，大多数患者接受了治疗，尤其是 TMZ 治疗。只有少数患者出现了毒性复发，这表明 TMZ 耐受性良好，并对 PFS 和 OS 产生了影响。
