Department of Hematology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Hematology, Catholic University Lymphoma Group, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Cancer Med. 2023 Apr;12(7):7911-7922. doi: 10.1002/cam4.5567. Epub 2023 Jan 31.
The diagnosis and management of primary intraocular lymphoma (PIOL) remain challenging. This study identified factors indicative of PIOL, described treatment outcomes, and determined modalities to prevent relapse.
We included 21 PIOL-diagnosed patients, seven via cytology, 12 via genetic evaluation, and two via interleukin (IL) level measurements, who underwent vitrectomy and received local intravitreal methotrexate (IV-MTX) injection. Clinical outcomes, including treatment response and relapse, were compared between patients receiving IV-MTX alone (n = 13) or IV-MTX with systemic high-dose methotrexate (HD-MTX) as prophylaxis (n = 8).
Twelve ophthalmologic and eight central nervous system (CNS) relapse cases within a median of 20.3 and 11.6 months were shown, regardless of the treatment modalities, with a median progression-free survival of 21.3 (95% confidence interval, 9.5-36.7) months. There was no difference in demographic characteristics between the two groups, except with the poorer performance status in patients in the HD-MTX prophylaxis group. Furthermore, patients demonstrated rapid elevations in the vitreous fluid IL-10/IL-6 cytokine ratio before ophthalmologic and CNS relapse. Therefore, diagnosis should be based on clinical signs and assisted by vitrectomy, cytologic, molecular, and cytokine studies.
For PIOL, aggressive systemic treatment equivalent to that of primary CNS lymphoma (PCNSL) is recommended because solely HD-MTX did not prevent or delay CNS relapse. To prevent PIOL relapse in the CNS efficiently, prospective trials with large numbers of patients and advanced therapeutic regimens are necessary. Furthermore, regular clinical follow-up is crucial, and the IL-10/IL-6 ratio can help evaluate relapse promptly.
原发性眼内淋巴瘤（PIOL）的诊断和治疗仍然具有挑战性。本研究确定了提示 PIOL 的因素，描述了治疗结果，并确定了预防复发的方法。
我们纳入了 21 例 PIOL 诊断患者，7 例通过细胞学检查，12 例通过基因评估，2 例通过白细胞介素（IL）水平测量，这些患者均接受了玻璃体切除术，并接受了局部玻璃体内甲氨蝶呤（IV-MTX）注射。比较了单独接受 IV-MTX 治疗（n=13）或 IV-MTX 联合全身高剂量甲氨蝶呤（HD-MTX）作为预防治疗（n=8）的患者的临床结果，包括治疗反应和复发情况。
显示出 12 例眼科和 8 例中枢神经系统（CNS）复发病例，中位时间分别为 20.3 个月和 11.6 个月，无论治疗方式如何，无进展生存中位数为 21.3（95%置信区间，9.5-36.7）个月。两组患者的人口统计学特征除了 HD-MTX 预防组患者的表现状态较差外，无差异。此外，患者在眼科和 CNS 复发前表现出玻璃体液中 IL-10/IL-6 细胞因子比率的快速升高。因此，诊断应基于临床体征，并辅助以玻璃体切除术、细胞学、分子和细胞因子研究。
对于 PIOL，建议采用与原发性中枢神经系统淋巴瘤（PCNSL）相当的强化全身治疗，因为单独使用 HD-MTX 并不能预防或延迟 CNS 复发。为了有效地预防 CNS 中 PIOL 的复发，需要进行前瞻性试验，纳入大量患者并采用先进的治疗方案。此外，定期的临床随访至关重要，IL-10/IL-6 比值有助于及时评估复发情况。
