Xie John, Jang Albert, Uemura Motohide, Nakazawa Shigeaki, Calimeri Teresa, Ferreri Andres Jm, Chen Shuang R, Schmid Janet L, Brown Theresa C, Socola Francisco, Safah Hana, Saba Nakhle S
Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States.
Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan.
Leuk Res Rep. 2021 Aug 3;16:100263. doi: 10.1016/j.lrr.2021.100263. eCollection 2021.
Primary adrenal lymphoma (PAL) and primary renal lymphoma (PRL) are rare extranodal lymphomas, predominantly of diffuse large B-cell lymphoma subtype. Primary adrenal and renal lymphomas (PARL) exhibit a high predilection for the central nervous system (CNS). Therefore, current guidelines support the use of CNS prophylaxis in PARL, particularly in cases of high-risk Central Nervous System International Prognostic Index (CNS-IPI). However, the route of administration (i.e. systemic vs. intrathecal chemotherapy) has not been clearly elucidated. With this in mind, we initiated an international collaboration and literature review to analyze 50 patient cases, 20 of which received CNS prophylaxis. Based on our analysis, we conclude that PARL may indicate a need for CNS chemo-prophylaxis in the form of systemic high-dose methotrexate (HD-MTX) over intrathecal methotrexate (IT-MTX), although IT-MTX may still have utility in certain cases.
原发性肾上腺淋巴瘤（PAL）和原发性肾淋巴瘤（PRL）是罕见的结外淋巴瘤，主要为弥漫性大B细胞淋巴瘤亚型。原发性肾上腺和肾淋巴瘤（PARL）对中枢神经系统（CNS）表现出高度偏好。因此，当前指南支持在PARL中使用中枢神经系统预防措施，特别是在高危中枢神经系统国际预后指数（CNS-IPI）的病例中。然而，给药途径（即全身化疗与鞘内化疗）尚未明确阐明。考虑到这一点，我们发起了一项国际合作并进行文献综述，以分析50例患者病例，其中20例接受了中枢神经系统预防措施。基于我们的分析，我们得出结论，PARL可能表明需要采用全身大剂量甲氨蝶呤（HD-MTX）而非鞘内甲氨蝶呤（IT-MTX）的形式进行中枢神经系统化学预防，尽管IT-MTX在某些情况下可能仍有用处。
