诊断时伴有中枢神经系统和全身同步受累的弥漫性大B细胞淋巴瘤和高级别B细胞淋巴瘤患者接受大剂量甲氨蝶呤和R-CHOP治疗的结果：一项单中心回顾性研究
Outcomes of patients with diffuse large B-cell and high-grade B-cell lymphomas with synchronous CNS and systemic involvement at diagnosis treated with high-dose methotrexate and R-CHOP: a single-center retrospective study.
作者信息
Fleming Megan, Huang Ying, Dotson Emily, Bond David A, Reneau John, Epperla Narendranath, Alinari Lapo, Brammer Jonathan, Christian Beth, Baiocchi Robert A, Maddocks Kami, Sawalha Yazeed
机构信息
Department of Pharmacy, The Ohio State University, Columbus, OH, USA.
Division of Hematology, The Ohio State University, Columbus, OH, USA.
出版信息
Ther Adv Hematol. 2022 Jul 23;13:20406207221112900. doi: 10.1177/20406207221112900. eCollection 2022.
BACKGROUND
The optimal treatment of patients with systemic diffuse large B-cell (DLBCL) or high-grade B-cell (HGBL) lymphomas with synchronous central nervous system (CNS) involvement at diagnosis is not well defined. High-dose methotrexate administered concurrently with R-CHOP (RM-CHOP) is a commonly used regimen, but data on outcomes achieved with this regimen are limited.
OBJECTIVE
To report our experience with RM-CHOP in patients with systemic DLBCL or HGBL with synchronous CNS involvement at diagnosis.
DESIGN
A single-center retrospective analysis.
METHODS
We identified consecutive patients with systemic DLBCL or HGBL with synchronous CNS involvement at diagnosis who were treated with RM-CHOP from January 2012 to January 2021.
RESULTS
Fifty patients were included with a median age of 62 years; 82% had DLBCL ( = 41) and 18% had HGBL ( = 9). Treatment with RM-CHOP was followed by consolidative autologous hematopoietic cell transplantation in 14 patients (28%). The complete response (CR) rate following RM-CHOP was 62%. With a median follow-up of 40 months, the median progression-free (PFS) and overall (OS) survivals were 16 and 58 months, and the 2-year PFS and OS were 41% and 57%, respectively. The 2-year cumulative incidence of CNS progression/relapse was 29%. Outcomes were particularly poor in HGBL, with median PFS and OS of 6 and 7 months, compared with median PFS and OS of 22 months and not reached in DLBCL, respectively. The outcomes of patients with relapsed/progressive disease were poor, with only 63% of patients receiving subsequent treatments and only 21% achieving CR to next subsequent treatment. Most patients (58%) with disease relapse/progression had CNS involvement which was associated with very poor outcomes (median OS of 2 months).
CONCLUSION
CNS involvement in aggressive B-cell non-Hodgkin lymphoma at diagnosis dictates clinical outcomes and requires more effective treatment options.
背景
对于诊断时伴有同步中枢神经系统（CNS）受累的系统性弥漫大B细胞（DLBCL）或高级别B细胞（HGBL）淋巴瘤患者，最佳治疗方案尚未明确。高剂量甲氨蝶呤与R-CHOP方案（RM-CHOP）同时使用是常用的治疗方案，但该方案的治疗效果数据有限。
目的
报告我们使用RM-CHOP方案治疗诊断时伴有同步CNS受累的系统性DLBCL或HGBL患者的经验。
设计
单中心回顾性分析。
方法
我们纳入了2012年1月至2021年1月期间接受RM-CHOP方案治疗的诊断时伴有同步CNS受累的系统性DLBCL或HGBL患者。
结果
共纳入50例患者，中位年龄62岁；82%为DLBCL（n = 41），18%为HGBL（n = 9）。14例患者（28%）在RM-CHOP方案治疗后接受了巩固性自体造血细胞移植。RM-CHOP方案后的完全缓解（CR）率为62%。中位随访40个月，中位无进展生存期（PFS）和总生存期（OS）分别为16个月和58个月，2年PFS和OS分别为41%和57%。CNS进展/复发的2年累积发生率为29%。HGBL患者的预后特别差，中位PFS和OS分别为6个月和7个月，而DLBCL患者的中位PFS和OS分别为22个月和未达到。复发/进展性疾病患者的预后较差，只有63%的患者接受了后续治疗，只有21%的患者在下一次后续治疗中达到CR。大多数疾病复发/进展的患者（58%）有CNS受累，这与非常差的预后相关（中位OS为2个月）。
结论
诊断时侵袭性B细胞非霍奇金淋巴瘤的CNS受累决定了临床结局，需要更有效的治疗选择。
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