Tringale Kathryn R, Scordo Michael, Yahalom Joachim, White Charlie, Zhang Zhigang, Schefflein Javin, Cederquist Gustav, Schaff Lauren R, DeAngelis Lisa, Imber Brandon S, Grommes Christian
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA.
Blood Adv. 2024 Dec 24;8(24):6195-6206. doi: 10.1182/bloodadvances.2024013780.
Consolidation for primary central nervous system lymphoma (PCNSL) after induction chemoimmunotherapy include whole-brain radiotherapy (WBRT; ≤24 Gy reduced-dose [RD], >24 Gy standard-dose) and cytarabine, nonmyeloablative chemotherapy (NMC), or autologous hematopoietic cell transplantation (AHCT). Comparative outcomes are lacking. Outcomes from 1983-2020 were stratified by decade and Memorial Sloan Kettering Cancer Center recursive partitioning analysis (RPA) class. Clinicodemographic associations were analyzed by multinomial logistic regression. Progression-free survival (PFS) and overall survival (OS) were analyzed by proportional hazards. Of 559 patients, 385 (69%) were consolidated. Median follow-up and OS were 7.4 and 5.7 years, respectively. WBRT use declined (61% (1990s) vs 12% (2010s)), whereas AHCT (4% (1990s) vs 32% (2010s)) and NMC (27% (1990s) vs 52% (2010s)) rose. Compared with RPA 1, RPA 2 was more likely to receive NMC. Those with partial response to induction were less likely to receive AHCT (odds ratio, 0.36; P = .02). Among 351 with complete response to consolidation, only receipt of rituximab, methotrexate, procarbazine, and vincristine induction was associated with improved PFS (hazard ratio, 0.5; P = .006). Among RPA 1, median PFS and OS were not reached for AHCT or RD-WBRT, vs 2.5 and 13.0 years, respectively, after NMC. Among RPA class 3, median PFS and OS after RD-WBRT were 4.6 and 10 years, vs 1.7 and 4.4 years after NMC. No significant adjusted survival differences were seen across consolidation strategies. NMC is increasingly used in lieu of RD-WBRT despite a trend toward less favorable PFS. RD-WBRT can be considered in patients ineligible for AHCT.
诱导化疗免疫治疗后原发性中枢神经系统淋巴瘤（PCNSL）的巩固治疗包括全脑放疗（WBRT；≤24 Gy为低剂量[RD]，>24 Gy为标准剂量）以及阿糖胞苷、非清髓性化疗（NMC）或自体造血细胞移植（AHCT）。目前尚缺乏比较性结果。对1983年至2020年的结果按十年和纪念斯隆凯特琳癌症中心递归分区分析（RPA）类别进行分层。通过多项逻辑回归分析临床人口统计学关联。采用比例风险模型分析无进展生存期（PFS）和总生存期（OS）。559例患者中，385例（69%）接受了巩固治疗。中位随访时间和OS分别为7.4年和5.7年。WBRT的使用有所下降（20世纪90年代为61%，2010年代为12%），而AHCT（20世纪90年代为4%，2010年代为32%）和NMC（20世纪90年代为27%，2010年代为52%）的使用有所增加。与RPA 1相比，RPA 2更有可能接受NMC。诱导治疗部分缓解的患者接受AHCT的可能性较小（比值比，0.36；P = 0.02）。在351例巩固治疗完全缓解的患者中，仅接受利妥昔单抗、甲氨蝶呤、丙卡巴肼和长春新碱诱导治疗与PFS改善相关（风险比，0.5；P = 0.006）。在RPA 1中，AHCT或低剂量WBRT的中位PFS和OS未达到，而NMC后的中位PFS和OS分别为2.5年和13.0年。在RPA 3类中，低剂量WBRT后的中位PFS和OS分别为4.6年和10年，而NMC后的中位PFS和OS分别为1.7年和4.4年。不同巩固治疗策略之间未观察到显著的调整后生存差异。尽管PFS有不太有利的趋势，但NMC越来越多地被用于替代低剂量WBRT。对于不符合AHCT条件的患者，可以考虑低剂量WBRT。
