Seidel Sabine, Margold Michelle, Kowalski Thomas, Baraniskin Alexander, Schroers Roland, Korfel Agnieszka, Thiel Eckhard, Weller Michael, Martus Peter, Schlegel Uwe
Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, In der Schornau 23-25, D-44892 Bochum, Germany.
Department of Hematology and Oncology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, In der Schornau 23-25, D-44892 Bochum, Germany.
Cancers (Basel). 2021 Jun 11;13(12):2934. doi: 10.3390/cancers13122934.
Patients with primary central nervous system lymphoma (PCNSL) not fulfilling inclusion criteria for clinical trials represent an underreported population. Thirty-four consecutive PCNSL patients seen at our center between 2005 and 2019 with exclusion criteria for therapeutic trials were analyzed (non-study patients) and compared with patients from the G-PCNSL-SG-1 (German PCNSL Study Group 1) study (study patients), the largest prospective multicenter trial on PCNSL, comprising 551 patients. Median follow up was 68 months (range 1-141) in non-study patients and 51 months (1-105) in study patients. Twenty-seven/34 (79.4%) non-study patients received high dose methotrexate (HDMTX), while seven/34 (20.6%) with a glomerular filtration rate (GFR) < 50 mL/min did not. Median overall survival (OS) was six months (95% confidence interval [CI] 0-21 months) in those 34 non-study patients. The 27 non-study patients treated with HDMTX were compared with 526/551 G-PCNSL-SG-1 study patients who had received HDMTX as well. Median OS was 20 months (95% CI 0-45)/21 months (95% CI 18-25) in 27 non-study/526 study patients ( = 0.766). Favorable prognostic factors in non-study patients were young age, application of HDMTX and early response on magnet resonance imaging (MRI). If HDMTX-based chemotherapy can be applied, long-term disease control is possible even in patients not qualifying for clinical trials. Initial response on early MRI might be useful for decision on treatment continuation.
不符合临床试验纳入标准的原发性中枢神经系统淋巴瘤（PCNSL）患者是一个报告不足的群体。对2005年至2019年间在我们中心就诊的34例连续PCNSL患者进行了分析（非研究患者），这些患者不符合治疗试验的纳入标准，并与G-PCNSL-SG-1（德国PCNSL研究组1）研究中的患者（研究患者）进行了比较，该研究是关于PCNSL的最大规模前瞻性多中心试验，包括551例患者。非研究患者的中位随访时间为68个月（范围1 - 141个月），研究患者为51个月（1 - 105个月）。27/34（79.4%）的非研究患者接受了大剂量甲氨蝶呤（HDMTX）治疗，而7/34（20.6%）肾小球滤过率（GFR）< 50 mL/min的患者未接受。这34例非研究患者的中位总生存期（OS）为6个月（95%置信区间[CI] 0 - 21个月）。将27例接受HDMTX治疗的非研究患者与526/551例同样接受了HDMTX治疗的G-PCNSL-SG-1研究患者进行比较。27例非研究/526例研究患者的中位OS分别为20个月（95% CI 0 - 45）/21个月（95% CI 18 - 25）（P = 0.766）。非研究患者的有利预后因素为年轻、应用HDMTX以及磁共振成像（MRI）早期反应。如果能够应用基于HDMTX的化疗，即使是不符合临床试验标准的患者也有可能实现长期疾病控制。早期MRI的初始反应可能有助于决定是否继续治疗。
