van Besien K, Ha C S, Murphy S, McLaughlin P, Rodriguez A, Amin K, Forman A, Romaguera J, Hagemeister F, Younes A, Bachier C, Sarris A, Sobocinski K S, Cox J D, Cabanillas F
The Division of Medicine, Department of Hematology and Neuro-oncology, MD Anderson Cancer Center, Houston, TX, USA.
Blood. 1998 Feb 15;91(4):1178-84.
To evaluate the incidence, risk factors, and outcome of central nervous system (CNS) recurrence in adult patients with non-Hodgkin's lymphoma, we evaluated 605 newly diagnosed patients with large-cell and immunoblastic lymphoma who participated in prospective chemotherapy studies. The Kaplan-Meier estimate of probability of CNS recurrence at 1 year after diagnosis was 4.5% (95% confidence interval [CI], 4.4 to 4.6). Twenty-four patients developed CNS recurrence after a median of 6 months from diagnosis (range, 0 to 44 months). In univariate analysis, an increased risk for CNS recurrence was associated with an advanced disease stage (P = .0014), an increased LDH (P = .0000), the presence of B-symptoms (P = . 0037), involvement of more than one extranodal site (P = .0000), poor performance status (P = .0005), and B-cell phenotype (P = .008). Bone marrow involvement (P = .005), involvement of parenchymal organs (P = .03), and involvement of skin, subcutaneous tissue, and muscle (P = .002) were also associated with an increased risk for CNS disease. Multivariate logistic regression analysis identified only involvement of more than one extranodal site (P = .0005) and an increased LDH (P = .0008) as independent predictors of CNS recurrence. Established CNS recurrence had a poor prognosis. Only 1 of 24 patients remains alive and the Kaplan-Meier estimate of probability of survival at 1 year after the diagnosis of CNS recurrence is only 25.3% (95% CI, 6.9 to 43.7). Intrathecal treatment provided symptomatic benefit in only 1 of 6 patients. Radiation treatment provided symptomatic improvement in 6 of 9 patients treated. However, remissions were short and followed by systemic or CNS recurrence. Serum LDH and involvement of more than one extranodal site are independent risk factors for CNS recurrence in patients with large-cell lymphoma. The presence of both risk factors identifies a patient group at high risk for CNS recurrence. Established CNS recurrence can be rapidly fatal. Transient responses occur after radiation treatment.
为评估成年非霍奇金淋巴瘤患者中枢神经系统（CNS）复发的发生率、危险因素及转归，我们对605例新诊断的大细胞和免疫母细胞淋巴瘤患者进行了评估，这些患者参与了前瞻性化疗研究。诊断后1年CNS复发概率的Kaplan-Meier估计值为4.5%（95%置信区间[CI]，4.4至4.6）。24例患者在诊断后中位6个月（范围0至44个月）出现CNS复发。单因素分析显示，CNS复发风险增加与疾病晚期（P = 0.0014）、乳酸脱氢酶（LDH）升高（P = 0.0000）、B症状的存在（P = 0.0037）、多个结外部位受累（P = 0.0000）、体能状态差（P = 0.0005）及B细胞表型（P = 0.008）相关。骨髓受累（P = 0.005）、实质器官受累（P = 0.03）以及皮肤、皮下组织和肌肉受累（P = 0.002）也与CNS疾病风险增加相关。多因素逻辑回归分析仅确定多个结外部位受累（P = 0.0005）和LDH升高（P = 0.0008）为CNS复发的独立预测因素。确诊的CNS复发预后较差。24例患者中仅1例存活，CNS复发诊断后1年生存概率的Kaplan-Meier估计值仅为25.3%（95%CI，6.9至43.7）。鞘内治疗仅使6例患者中的1例获得症状改善。放射治疗使9例接受治疗的患者中的6例症状得到改善。然而，缓解期短暂，随后出现全身或CNS复发。血清LDH和多个结外部位受累是大细胞淋巴瘤患者CNS复发的独立危险因素。这两种危险因素同时存在可确定为CNS复发的高危患者组。确诊的CNS复发可迅速致命。放射治疗后出现短暂反应。
