Mocikova Heidi, Janikova Andrea, Sykorova Alice, Prochazka Vit, Pirnos Jan, Duras Juraj, Kopeckova Katerina, Steinerova Katerina, Pytlik Robert, Blahovcova Petra, Salek David, Kozak Tomas, Bachanova Veronika, Belada David
Fakultni nemocnice Kralovske Vinohrady, Department of Haematology and Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University Brno, Brno, Czech Republic.
Ann Hematol. 2025 Jan;104(1):675-684. doi: 10.1007/s00277-024-06025-y. Epub 2024 Oct 1.
Patients with testicular lymphoma are at an increased risk of central nervous system (CNS) disease. Optimal strategy for CNS relapse prevention is unknown. We analyzed treatment strategies, cumulative incidence of CNS relapse and prognosis in 229 patients with diffuse large B-cell lymphoma (DLBCL) and testicular involvement: 157 primary testicular lymphomas (PTL) in clinical stages IE/IIE and 72 patients in advanced stages (T-DLBCL) IIIE/IV. Treatments for PTL vs. T-DLBCL included: rituximab-based chemotherapy (80.9% vs. 90.3%), orchiectomy (94.3% vs. 65.3%) and contralateral testicular irradiation (59.8% vs. 44.4%). Majority (84.3%) received CNS prophylaxis with similar rates of prophylactic methotrexate (intravenous 19.1% vs. 16.6%, intrathecal 40.8% vs. 40.4%, or both 24.2% vs. 27.8%) between PTL and T-DLBCL (p = 0.89). Median follow-up was 51.8 months. CNS relapses occurred in 14 (6.1%) of 63 relapsing patients. The 5-year cumulative incidence of CNS relapse in PTL was 4.5% and in T-DLBCL 12.1%. Median time to CNS relapse was 21.9 months. In univariate analyses, orchiectomy was the single significant factor associated with lower risk of CNS relapse in PTL (HR = 0.11 [95% CI, 0-0.124], p = 0.001). Rituximab significantly reduced CNS relapse risk in T-DLBCL (HR = 0.1002, p = 0.0005). Median progression-free survival (PFS) and overall survival (OS) following CNS relapse was dismal in T-DLBCL compared to PTL (PFS 1.6 vs. 37.8 months, p = 0.04 and OS 2.3 vs. 37.8 months, p = 0.05). This study confirmed a favorable impact of rituximab in prevention of CNS relapse in T-DLBCL. Methotrexate prophylaxis did not alter CNS relapse risk. Prognosis of CNS relapse is particularly poor in T-DLBCL.
睾丸淋巴瘤患者发生中枢神经系统（CNS）疾病的风险增加。预防CNS复发的最佳策略尚不清楚。我们分析了229例弥漫性大B细胞淋巴瘤（DLBCL）伴睾丸受累患者的治疗策略、CNS复发的累积发生率和预后：157例临床分期为IE/IIE的原发性睾丸淋巴瘤（PTL）和72例晚期（T-DLBCL）IIIE/IV期患者。PTL与T-DLBCL的治疗方法包括：基于利妥昔单抗的化疗（80.9%对90.3%）、睾丸切除术（94.3%对65.3%）和对侧睾丸照射（59.8%对44.4%）。大多数（84.3%）接受了CNS预防，PTL和T-DLBCL之间预防性甲氨蝶呤的使用比例相似（静脉注射19.1%对16.6%，鞘内注射40.8%对40.4%，或两者兼用24.2%对27.8%）（p = 0.89）。中位随访时间为51.8个月。63例复发患者中有14例（6.1%）发生CNS复发。PTL的5年CNS复发累积发生率为4.5%，T-DLBCL为12.1%。CNS复发的中位时间为21.9个月。在单因素分析中，睾丸切除术是与PTL中CNS复发风险较低相关的唯一显著因素（HR = 0.11 [95% CI，0 - 0.124]，p = 0.001）。利妥昔单抗显著降低了T-DLBCL中的CNS复发风险（HR = 0.1002，p = 0.0005）。与PTL相比，T-DLBCL中CNS复发后的中位无进展生存期（PFS）和总生存期（OS）较差（PFS 1.6对37.8个月，p = 0.04；OS 2.3对37.8个月，p = 0.05）。本研究证实了利妥昔单抗在预防T-DLBCL中CNS复发方面的有利作用。甲氨蝶呤预防并未改变CNS复发风险。T-DLBCL中CNS复发的预后尤其差。
