文章：

大剂量甲氨蝶呤可有效预防弥漫性大B细胞淋巴瘤的孤立性中枢神经系统复发

High-dose methotrexate is effective for prevention of isolated CNS relapse in diffuse large B cell lymphoma

原文发布日期：2021-08-12

DOI: 10.1038/s41408-021-00535-y

类型: Article

开放获取: 是

英文摘要：

The role of central nervous system (CNS) prophylaxis with high-dose methotrexate (HDMTX) in DLBCL is controversial. In this retrospective study, we evaluated the efficacy of prophylactic HDMTX on isolated CNS relapse, concomitant CNS and systemic relapse, systemic relapse, and survival outcomes in 226 patients with newly diagnosed DLBCL and high-risk CNS International Prognostic Index (CNS-IPI) score treated with RCHOP. The three-year risk of isolated CNS relapse was significantly lower in patients who received HDMTX, at 3.1% compared to 14.6% (P = 0.032) in those who did not. However, neither concomitant CNS-systemic relapse rates, systemic relapse rates, nor three-year PFS and OS were significantly different between treatment groups in multivariable analysis. Among propensity score-matched patients (N = 102), HDMTX was also associated with significantly lower isolated CNS relapse rates (HR 0.06, 95% CI 0.004–0.946, P = 0.046). HDMTX was well tolerated with manageable toxicities when given at a dose of 3 g/m2 by day 3 of RCHOP chemotherapy. Using propensity score matching and multivariable regression to yield treatment groups with well-balanced covariates, we showed that prophylactic HDMTX improved isolated CNS relapse rates but did not decrease concomitant CNS-systemic relapse rates, systemic relapse rates, or improve survival outcomes.
 

摘要翻译： 

大剂量甲氨蝶呤（HDMTX）在中枢神经系统（CNS）预防治疗在弥漫性大B细胞淋巴瘤（DLBCL）中的作用存在争议。本回顾性研究评估了226例新诊断DLBCL且具有高中枢神经系统国际预后指数（CNS-IPI）评分、接受RCHOP方案治疗的患者中，预防性HDMTX对孤立性中枢神经系统复发、中枢神经系统联合全身性复发、全身性复发及生存结局的疗效。接受HDMTX治疗的患者三年孤立性中枢神经系统复发风险显著降低，为3.1%，而未接受者为14.6%（P=0.032）。然而，在多变量分析中，治疗组间在中枢神经系统联合全身性复发率、全身性复发率以及三年无进展生存期和总生存期方面均无显著差异。在倾向评分匹配的患者（N=102）中，HDMTX同样与显著降低的孤立性中枢神经系统复发率相关（风险比0.06，95%置信区间0.004–0.946，P=0.046）。当在RCHOP化疗第3天以3g/m²剂量给药时，HDMTX耐受性良好，毒性可控。通过倾向评分匹配和多变量回归构建协变量均衡的治疗组，我们发现预防性HDMTX改善了孤立性中枢神经系统复发率，但并未降低中枢神经系统联合全身性复发率、全身性复发率或改善生存结局。

原文链接：

High-dose methotrexate is effective for prevention of isolated CNS relapse in diffuse large B cell lymphoma