文章：

弥漫性大B细胞淋巴瘤伴中枢神经系统高复发风险时，采用鞘内或高剂量甲氨蝶呤预防

Prophylaxis with intrathecal or high-dose methotrexate in diffuse large B-cell lymphoma and high risk of CNS relapse

原文发布日期：2021-06-16

DOI: 10.1038/s41408-021-00506-3

类型: Article

开放获取: 是

英文摘要：

Although methotrexate (MTX) is the most widely used therapy for central nervous system (CNS) prophylaxis in patients with diffuse large B-cell lymphoma (DLBCL), the optimal regimen remains unclear. We examined the efficacy of different prophylactic regimens in 585 patients with newly diagnosed DLBCL and high-risk for CNS relapse, treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like regimens from 2001 to 2017, of whom 295 (50%) received prophylaxis. Intrathecal (IT) MTX was given to 253 (86%) and high-dose MTX (HD-MTX) to 42 (14%). After a median follow-up of 6.8 years, 36 of 585 patients relapsed in the CNS, of whom 14 had received prophylaxis. The CNS relapse risk at 1 year was lower for patients who received prophylaxis than patients who did not: 2% vs. 7.1%. However, the difference became less significant over time (5-year risk 5.6% vs. 7.5%), indicating prophylaxis tended to delay CNS relapse rather than prevent it. Furthermore, the CNS relapse risk was similar in patients who received IT and HD-MTX (5-year risk 5.6% vs. 5.2%). Collectively, our data indicate the benefit of MTX for CNS prophylaxis is transient, highlighting the need for more effective prophylactic regimens. In addition, our results failed to demonstrate a clinical advantage for the HD-MTX regimen.
 

摘要翻译： 

尽管甲氨蝶呤是弥漫性大B细胞淋巴瘤患者中枢神经系统预防中最广泛使用的疗法，但最佳治疗方案仍不明确。本研究对2001年至2017年间接受利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松方案治疗的585例新诊断DLBCL且具有中枢神经系统复发高风险患者进行了分析，其中295例接受了预防治疗。在预防治疗组中，253例接受鞘内甲氨蝶呤注射，42例接受大剂量甲氨蝶呤治疗。中位随访6.8年后，585例患者中共有36例出现中枢神经系统复发，其中14例曾接受预防治疗。预防治疗组患者的1年中枢神经系统复发风险低于未预防组。然而随时间推移差异逐渐减弱，表明预防治疗更倾向于延缓而非完全阻止中枢神经系统复发。此外，接受鞘内注射与大剂量静脉给药患者的复发风险无显著差异。综合分析表明，甲氨蝶呤对中枢神经系统的预防效益具有暂时性特征，这凸显了开发更有效预防方案的必要性。同时本研究结果未能证实大剂量甲氨蝶呤方案具有临床优势。

原文链接：

Prophylaxis with intrathecal or high-dose methotrexate in diffuse large B-cell lymphoma and high risk of CNS relapse