大剂量甲氨蝶呤(HD-MTX)联合利妥昔单抗治疗初发原发性中枢神经系统淋巴瘤(PCNSL)的疗效

 目的  大剂量甲氨蝶呤(high-dose methotrexate,HD-MTX)联合利妥昔单抗(rituximab,R)与单用HD-MTX治疗初发的原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)效果的评价。方法  收集2012年1月1日至2015年12月31日在复旦大学附属华山医院就诊的初发PCNSL患者的临床资料,采用回顾性的队列研究,对于接受HD-MTX联合R及单用HD-MTX治疗的患者进行疗效和预后的生存分析。结果  共有73例患者纳入研究,HD-MTX+R组38例,HD-MTX组35例。HD-MTX+R组患者的完全缓解(complete response,CR)率为84%,HD-MTX组患者的CR率为83% (P=0.878)。HD-MTX+R组患者的中位生存时间(overall survival,OS)为53个月,HD-MTX组患者的中位生存时间为27个月(P=0.047)。HD-MTX+R组患者的中位无进展生存期(progression-free survival,PFS)为44个月,HD-MTX组患者的中位无进展生存期为17个月(P=0.02)。两组患者两组的不良反应发生率差异无统计学意义。结论  HD-MTX+R组与HD-MTX组相比CR率相似,但是加用R有利于延长PCNSL患者的OS和PFS,且加用R不会增加不良反应。

The therapeutic effect of high-dose methotrexate (HD-MTX) with rituximab in newly diagnosed primary central nervous system lymphoma (PCNSL)

Objective    To evaluate therapeutic effect of high-dose methotrexate(HD-MTX)combined with rituximab (R) compared with HD-MTX in patients with newly diagnosed primary central nervous system lymphomas(PCNSLs).Methods    With a retrospective cohort,we collected the clinical data of patients with newly diagnosed PCNSL at Huashan Hospital of Fudan University since 2012 January 1 to 2015 December 31.We analyzed the therapeutic effect and prognosis of the patients received HD-MTX combined with R and HD-MTX.Results    A total of 73 patients were identified,38 received HD-MTX+R,35 received HD-MTX.Complete response (CR) rates was 84% in the HD-MTX+R group and 83% in the HD-MTX group (P=0.878).Median overall survival (OS) was 53 months in the HD-MTX+R group and 27 months in the HD-MTX group (P=0.047).Median progression-free survival (PFS) was 44 months in the HD-MTX+R group and 17 months in the HD-MTX group (P=0.020).The differences of incidence of adverse between the two groups had no statistical significance.Conclusions    CR rate of HD-MTX+R and HD-MTX cohorts is similar,meanwhile addition of rituximab to HD-MTX appears to improve OS and PFS without increasing adverse reactions in patients with newly diagnosed PCNSL.