Fischer Thais, Zing Natalia Pc, Fortier Sergio C, Schmidt Jayr, Silveira Talita B, Chiattone Carlos S
Santa Casa de Sao Paulo School of Medical Sciences, São Paulo SP, Brazil; Ac Camargo Cancer Center, São Paulo, SP, Brazil.
Santa Casa de Sao Paulo School of Medical Sciences, São Paulo SP, Brazil.
Hematol Transfus Cell Ther. 2024 Apr-Jun;46(2):137-145. doi: 10.1016/j.htct.2023.02.003. Epub 2023 Mar 21.
The diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) and, despite all the progress in this field, central nervous system infiltration (CNSi) still occurs at an incidence of 2-10%. The objective of the present study was to evaluate the Central Nervous System International Prognostic Index (CNS-IPI) score in daily practice regarding the reproducibility in a heterogeneous cohort apart from a clinical trial.
Primary DLBCL patients were eligible for this study, between January 2007 and January 2017. All patients were treated with rituximab-based chemotherapy, mostly R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). The CNSi was diagnosed by liquor (positive cytology and/or immunophenotype), computerized tomography, magnetic resonance image and/or fluorodeoxy-glucose-positron emission tomography, requested only in symptomatic patients when the CNSi was clinically suspected. The CNS-IPI was assessed by graphical comparison and calibration.
After applying the inclusion/exclusion criteria, 322 patients were available for the analysis. The median follow-up was 60 months and the median age was 58 years. Seven patients experienced CNSi, characterizing an incidence of 2.17% (7/322). Comparing groups of patients with and without CNSi, we observed that the lactate dehydrogenase (LDH), number of extranodal sites, IPI, kidney/adrenal and absence of complete response were statistically different. The CNS-IPI model stratified patients in a three-risk group model as low-, intermediate- and high-risk. In our cohort, using the same stratification, we obtained an equivalent the 2-year rate of CNS relapse of 0.0%, 0.8% and 13.8%, respectively.
Our study reinforces the reproducibility of the CNS-IPI, specifically apart from clinical trials, and suggests the CNS-IPI score as a tool to guide therapy.
弥漫性大B细胞淋巴瘤（DLBCL）是最常见的非霍奇金淋巴瘤（NHL）类型，尽管该领域取得了诸多进展，但中枢神经系统浸润（CNSi）的发生率仍为2%-10%。本研究的目的是在日常实践中评估中枢神经系统国际预后指数（CNS-IPI）评分在异质性队列中的可重复性，该队列并非来自临床试验。
2007年1月至2017年1月期间的原发性DLBCL患者符合本研究条件。所有患者均接受基于利妥昔单抗的化疗，主要为R-CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松）。仅在临床怀疑有CNSi的有症状患者中，通过脑脊液（阳性细胞学和/或免疫表型）、计算机断层扫描、磁共振成像和/或氟脱氧葡萄糖-正电子发射断层扫描来诊断CNSi。通过图形比较和校准来评估CNS-IPI。
应用纳入/排除标准后，有322例患者可供分析。中位随访时间为60个月，中位年龄为58岁。7例患者发生CNSi，发生率为2.17%（7/322）。比较有和无CNSi的患者组，我们观察到乳酸脱氢酶（LDH）、结外部位数量、IPI、肾脏/肾上腺以及无完全缓解在统计学上存在差异。CNS-IPI模型将患者分为低风险、中风险和高风险三个风险组模型。在我们的队列中，采用相同的分层方法，我们分别获得了2年CNS复发率为0.0%、0.8%和13.8%。
我们的研究强化了CNS-IPI的可重复性，特别是在临床试验之外，并建议将CNS-IPI评分作为指导治疗的工具。
