Korfel A, Thiel E
Department of Hematology and Oncology, Universitäts Klinikum Benjamin Franklin, Freie Universität Berlin, Germany.
Leuk Lymphoma. 1998 Aug;30(5-6):609-17. doi: 10.3109/10428199809057573.
The treatment of patients with primary non-Hodgkin's lymphoma of the central nervous system (PCNSL) is still of limited success, as compared with other extranodal sites. The poor results obtained with radiotherapy alone can be improved by adding chemotherapy reaching a median survival up to over 30 months and 5-years-survival rate up to 35%. The optimal management for patients with CNS relapse of systemic lymphoma remains uncertain and their prognosis is even worse. Here, we describe our preliminary data on the treatment of patients with CNS lymphoma with a new regimen composed of CNS-penetrating drugs, namely: carmustine (BCNU) 80 mg/m2 i.v. dl, methotrexate 1500 mg/m2 over 24h i.v. d2, procarbacine 100 mg/m2 p.o. d1-8, and dexamethasone 3 x 8 mg p.o. d1-14. An average of 3 treatment courses were given under response control seen using CT-scan or NMR. Patients with positive CSF cytology received additionally intrathecal therapy with methotrexate. Until now between March 1994 and September 1997, 7 patients with PCNSL and 4 patients with CNS relapse of systemic lymphoma have been treated. The median age of the patients was 56 (range, 39-74); 5 patients were > or =60 years old. Three patients had multifocal disease. Whole brain radiotherapy with 4000 to 5000 cGy was given in 7 patients (cerebrospinal in 1 patient). Complete response at the end of chemotherapy was achieved in 6 patients, and a partial response in two. Most remarkably, 2 elderly patients (70 and 57 years), 1 patient with multifocal disease and 1 with simultaneous CNS and systemic relapse after chemotherapy had a complete remission lasting for 40 months, and a partial remission lasting for 37 months, respectively.
与其他结外部位相比，中枢神经系统原发性非霍奇金淋巴瘤（PCNSL）患者的治疗成功率仍然有限。单纯放疗效果不佳，联合化疗可改善疗效，中位生存期可达30多个月，5年生存率可达35%。系统性淋巴瘤中枢神经系统复发患者的最佳治疗方案仍不确定，其预后更差。在此，我们描述了用一种由可透过中枢神经系统的药物组成的新方案治疗中枢神经系统淋巴瘤患者的初步数据，该方案即：卡莫司汀（BCNU）80mg/m²静脉注射第1天，甲氨蝶呤1500mg/m²在24小时内静脉注射第2天，丙卡巴肼100mg/m²口服第1 - 8天，地塞米松3×8mg口服第1 - 14天。在CT扫描或核磁共振监测反应的情况下，平均给予3个疗程的治疗。脑脊液细胞学检查阳性的患者额外接受甲氨蝶呤鞘内治疗。截至1994年3月至1997年9月，已治疗7例PCNSL患者和4例系统性淋巴瘤中枢神经系统复发患者。患者的中位年龄为56岁（范围39 - 74岁）；5例患者年龄≥60岁。3例患者有多发病灶。7例患者接受了4000至5000cGy的全脑放疗（1例患者为脑脊髓放疗）。化疗结束时6例患者达到完全缓解，2例患者部分缓解。最显著的是，2例老年患者（70岁和57岁）、1例多病灶患者和1例化疗后同时出现中枢神经系统和系统性复发的患者分别获得了持续40个月的完全缓解和持续37个月的部分缓解。
