原发性中枢神经系统非霍奇金淋巴瘤患者的一线大剂量治疗和自体血干细胞移植——61 例患者的单中心经验。
First-line high-dose therapy and autologous blood stem cell transplantation in patients with primary central nervous system non-Hodgkin lymphomas-a single-centre experience in 61 patients.
机构信息
Department of Oncology, University Hospital Zuerich, Zuerich, Switzerland.
Department of Internal Medicine A, Hospital Merheim, Cologne, Germany.
出版信息
Ann Hematol. 2022 Mar;101(3):607-616. doi: 10.1007/s00277-021-04745-z. Epub 2022 Jan 4.
Primary central nervous system non-Hodgkin lymphomas (PCNS-NHLs) are extranodal B-cell lymphomas with poor prognosis. The role of high-dose therapy (HDT) followed by autologous blood stem cell transplantation (ASCT) as first-line therapy is still not clear. We retrospectively collected long-term follow up data of 61 consecutive patients with PCNS-NHL at the University Hospital Düsseldorf from January 2004 to December 2016. Thirty-six patients were treated with conventional chemoimmunotherapy (cCIT) only (CT-group). Seventeen patients received an induction cCIT followed by HDT and ASCT. In the CT-group, the overall response rate (ORR) was 61% (CR 47%, PR 14%), and there were 8% treatment-related deaths (TRD). Progression-free survival (PFS) was 31.8 months, and overall survival (OS) was 57.3 months. In the HDT-group, the ORR was 88% (59% CR, 29% PR), and there were 6% TRD. Median PFS and OS were not reached at 5 years. The 5-year PFS and OS were 64.7%. After a median follow up of 71 months, 10 patients (59%) were still alive in CR/PR following HDT and ASCT, one patient was treated for progressive disease (PD), and 7 had died (41%, 6 PD, 1 TRD). All patients achieving CR prior to HDT achieved durable CR. In the CT-group, 8 patients (22%) were alive in CR/PR after a median follow-up of 100 months. Twenty-eight patients died (78%, 24 PD, 2 TRD, 2 deaths in remission). In the univariate analysis, the HDT-group patients had significantly better PFS (not reached vs 31.8 months, p = 0.004) and OS (not reached vs 57.3 months, p = 0.021). The multivariate analysis showed HDT was not predictive for survival. Treatment with HDT + ASCT is feasible and offers the chance for long-term survival with low treatment-related mortality in younger patients. In this analysis, ORR, PFS and OS were better with HDT than with conventional cCIT alone. This result was not confirmed in the multivariate analysis, and further studies need to be done to examine the role of HDT in PCNSL.
原发性中枢神经系统非霍奇金淋巴瘤（PCNS-NHL）是一种预后不良的结外 B 细胞淋巴瘤。大剂量化疗（HDT）联合自体造血干细胞移植（ASCT）作为一线治疗的作用仍不明确。我们回顾性收集了 2004 年 1 月至 2016 年 12 月期间杜塞尔多夫大学医院 61 例 PCNS-NHL 患者的长期随访数据。36 例患者仅接受常规化疗免疫治疗（cCIT）（CT 组）。17 例患者接受诱导 cCIT 后行 HDT 和 ASCT。在 CT 组中，总缓解率（ORR）为 61%（完全缓解率 47%，部分缓解率 14%），有 8%的治疗相关死亡率（TRD）。无进展生存期（PFS）为 31.8 个月，总生存期（OS）为 57.3 个月。在 HDT 组中，ORR 为 88%（完全缓解率 59%，部分缓解率 29%），TRD 为 6%。5 年时无进展生存期和总生存期均未达到。5 年的 PFS 和 OS 为 64.7%。在 HDT 和 ASCT 后，中位随访 71 个月时，10 例（59%）患者仍处于完全缓解/部分缓解，1 例患者因疾病进展（PD）接受治疗，7 例患者死亡（41%，6 例 PD，1 例 TRD）。所有在 HDT 前达到完全缓解的患者均获得持久的完全缓解。在 CT 组中，8 例（22%）患者在中位随访 100 个月后仍处于完全缓解/部分缓解。28 例患者死亡（78%，24 例 PD，2 例 TRD，2 例缓解期死亡）。单因素分析显示，HDT 组患者的 PFS（未达到 vs 31.8 个月，p=0.004）和 OS（未达到 vs 57.3 个月，p=0.021）显著改善。多因素分析显示，HDT 并不预测生存。在年轻患者中，HDT+ASCT 的治疗是可行的，且具有较低的治疗相关死亡率，为长期生存提供了机会。在本分析中，ORR、PFS 和 OS 均优于单独接受常规 cCIT。这一结果在多因素分析中并未得到证实，需要进一步的研究来检验 HDT 在 PCNSL 中的作用。
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