原发中枢神经系统淋巴瘤临床特点与疗效:40例分析

背景与目的:原发中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)近年来在免疫功能正常的人群中发病率有所上升。本研究的目的是探讨PCNSL的临床特征、治疗及预后。方法:回顾性分析经病理证实的40例PCNSL的临床资料。结果:40例患者中24例(60.0%)主要表现为颅内高压;21例(52.5%)单发病灶;28例(70.0%)为弥漫大B细胞淋巴瘤。12例(30.0%)手术全切肿瘤,中位KPS评分70;14例(35.0%)接受HD-MTX为主的化疗加全脑放疗;19例(47.5%)接受鞘内化疗。40例患者Kaplan-Meier分析总中位生存时间为26个月,2年生存率65.2%;HD-MTX联合全脑放疗组患者完全缓解率73.3%,中位生存时间38.5个月,2年生存率80.6%。结论:PCNSL患者临床表现主要为颅内压增高,单发病灶多见,B细胞亚型多见,HD-MTX联合适当剂量的全脑放射治疗可延长生存期,年龄、术后KPS评分影响预后。     

34例原发性中枢神经系统恶性淋巴瘤临床分析

目的：分析免疫功能正常的中国人原发性中枢神经系统淋巴瘤（PCNSL）的临床资料,探讨PCNSL的临床特征,评价大剂量甲氨蝶呤（HD-MTX）加全脑放疗（WBRT）治疗PCNSL的疗效.方法：回顾性分析34例经病理证实的PCNSL患者的临床资料以及治疗效果,Kaplan-Meier法分析患者生存期.结果：34例PCNSL患者中B细胞淋巴瘤31例（91.2%）,T细胞淋巴瘤3例（8.8%）;所有患者治疗后评价完全缓解率（CR）41.2%,2年生存率60.2%;病理类型和是否接受HD-MTX加放疗是影响PCNSL生存期的主要原因（P＜0.05）.结论：PCNSL以颅内高压为主要表现,B细胞亚型占绝对优势,具有独特的预后因素,HD-MTX联合放疗是PCNSL有效的治疗方法.     

14例原发性脑恶性淋巴瘤临床分析

目的 探讨原发性脑淋巴瘤的临床特点、治疗方法及预后情况.方法 回顾性分析14例原发性脑淋巴瘤的临床资料.结果 病理结果:弥漫大B细胞淋巴瘤8例,未分型的B细胞淋巴瘤6例.治疗方法:12例行手术切除,11例接受放疗,其中10例结合化疗;2例未手术切除,直接放疗,其中1例结合化疗.全组均可评价疗效,2例获完全切除的患者未发现肿瘤残瘤,其他12例中2例CR,2例PR,3例SD,5例PD.全组患者的生存期为3～65个月(中位生存期15个月),1、3、5年生存率分别为77%、32%和32%.全组死亡因为主要系局部复发,其中1例全切术后加辅助放化疗者生存期达65个月,1例未行辅助治疗的部分切除术患者仅生存3个月;9例单发病灶生存3～65个月(平均生存期32个月),5例多发病灶生存6～24个月(平均生存期16个月).结论 联合手术、化疗、放疗的综合治疗可延长原发性脑淋巴瘤患者的生存期.     

原发性中枢神经系统淋巴瘤18例

 目的　研究原发性中枢神经系统淋巴瘤（PCNSL）的临床、病理特点及治疗方法。方法　回顾性分析18例PCNSL患者的临床表现、病理特征及治疗效果。结果　18例PCNSL,单病灶14例（77.8 %）,多病灶4例（22.2 %）,最常见部位为额叶6例（27.8 %）、颞叶5例（22.2 %）,主要临床表现为头痛、恶心、呕吐13例（72.2 %）。病理检查皆为B细胞来源,其中弥漫性大B细胞淋巴瘤12例（66.7 %）。全组中位生存期（MST）15.5个月,2年生存率33.3 %。结论　PCNSL临床表现无特异性,病理以弥漫性大B细胞为主, 全脑放疗结合大剂量化疗是最佳治疗手段     

替莫唑胺为主的化疗联合放疗治疗原发中枢神经系统淋巴瘤的临床观察

  目的  评价以替莫唑胺为主的化疗联合放疗治疗原发中枢神经系统淋巴瘤(PCNSL)的疗效及不良反应。   方法  对2006年6月至2012年3月山东省肿瘤医院收治的24例PCNSL患者采用全脑放疗同步替莫唑胺化疗之后, 给予替莫唑胺+奈达铂+长春新碱化疗方案行6~8个周期的辅助化疗。观察患者肿瘤缓解状态、总生存期及不良反应。   结果  24例均完成治疗。随访3~63个月, 中位生存时间为25个月, 治疗后CR者41.7%(10/24), PR者29.2%(7/24), SD者12.5%(3/24), PD者16.7%(4/24), 客观肿瘤缓解率(ORR)为70.8%。Kaplan-Meier分析显示该治疗方案优于大剂量甲氨蝶呤(HD-MTX)联合放疗治疗PCNSL的效果, 亦优于单药替莫唑胺治疗PCNSL的效果, 且不良反应小。   结论   替莫唑胺为主的化疗联合放疗治疗PCNSL较安全、效果好。      

原发性中枢神经系统淋巴瘤35例临床及预后分析

目的:探讨原发中枢神经系统淋巴瘤(PCNSL)临床特点、诊治方案及临床疗效。方法:总结2001年1月-2008年1月收治的35例PCNSL患者,均经病理证实为B细胞来源非霍奇金淋巴瘤并接受放疗,其中25例放疗后接受化疗。结合文献对原发性中枢神经系统淋巴瘤患者的临床特点、病理学检查、影像学表现、治疗及预后进行回顾性分析。结果:本病以中老年人多见,发病急,病程短,病情进展快。临床表现复杂,颅内高压为主要表现之一。CT、MRI增强扫描病灶多呈均匀明显强化,可单发或多发。35例患者中位生存时间23月,1年生存率74.3%,3年生存率25.7%,5年生存率5.71%。肿瘤全切及局部切除者,生存率未见明显统计学差异(P=0.053),加化疗疗效优于不加化疗(P=0.012)。结论:PCNSL临床表现多样,影像学缺乏特异性,极易误诊,确诊需要依靠病理学检查,最佳治疗方案是手术加放疗、化疗的联合治疗。PCNSL侵袭性强,生存期短,其预后主要与发病年龄、多灶性、一般状态有关。     

替莫唑胺化疗方案联合全脑放疗治疗非免疫功能缺陷PCNSL的临床观察

目的研究替莫唑胺化疗方案联合全脑放疗治疗非免疫功能缺陷PCNSL的临床效果。方法回顾性分析应用替莫唑胺化疗方案联合全脑放疗治疗的168例非免疫功能缺陷PCNSL患者的基本资料、临床表现、化疗周期、化疗疗效、不良反应、生存分析、随访时间等数据信息,研究了替莫唑胺化疗方案联合全脑放疗治疗非免疫功能缺陷PCNSL患者的临床疗效。结果 168例患者治疗后随访时间为0~24个月;平均生存期为(11.8±2.3)个月。CR 51例(30.35%)、PR 63例(37.50%)、SD 23例(13.69%)、PD 31例(18.45%)、有效率67.86%以及临床控制率81.55%。不良反应主要有:贫血、骨髓抑制、疲劳、恶心呕吐等。结论替莫唑胺化疗方案联合全脑放疗治疗能够比较有效地提高患者生存率,值得临床推广应用。     

非小细胞肺癌脑转移不同治疗的疗效分析

目的比较不同治疗方法在非小细胞肺癌脑转移中的作用。方法回顾性分析56例非小细胞肺癌脑转移患者,7例接受开颅手术治疗,13例接受开颅手术 术后放疗,22例接受全脑放疗(WBRT),9例接受立体定向放射治疗(SRT),5例接受全脑放疗 立体定向放疗,全部病例定期随访直至死亡。结果总的1年生存率为39.2%,中位生存期是220天。单纯开颅手术组1年生存率为71.4%,中位生存期517天;开颅手术 术后放疗组1年生存率76.9%,中位生存期533天;全脑放疗组1年生存率4.5%,中位生存期78天;立体定向放疗组1年生存率44.4%,中位生存期187天;全脑放疗 立体定向放疗组1年生存期62.0%,中位生存期509天;年龄大于60岁组1年生存率为26.7%,年龄小于60岁组1年生存率53.8%。结论对于一般情况较好,能耐受手术的单发脑转移患者,开颅手术 术后放疗是一种较好的治疗手段。无开颅手术条件的脑转移患者,选择SRT或SRT联合WBRT较单纯WBRT治疗可能更有效。     

原发性中枢神经系统淋巴瘤临床及预后分析

目的:总结原发性中枢神经系统淋巴瘤(PCNSL)的临床特点、诊治方案及临床疗效.方法:回顾收活的21例PCNSL患者,均为病理确诊的B细胞来源非霍奇金淋巴瘤,其中5例接受单纯放疗,16例接受放化疗.对病理学检查、影像学表现、治疗及预后进行总结分析.结果:PCNSL以中老年人多见,发病急,病程短,病情进展快.临床表现复杂,颅内高压为主要表现之一.CT、MR增强扫描病灶多呈均匀明显强化,可单发或多发.21例患者中位生存时间22个月,1、3和5年生存率分别为76.2％、28.6％和4.76％.放化疗疗效优于单纯放疗,P=0.029.结论:PCNSL临床表现多样,影像学缺乏特异性,极易误诊,确诊需要依靠病理学检查,其最佳治疗方案是三维立体定向穿刺活检加放疗、化疗的联合治疗.PCNSL侵袭性强,生存期短,其预后主要与发病年龄、多灶性和体力状况有关.     

非免疫抑制相关的脑原发淋巴瘤19例诊治分析

目的:分析免疫功能正常患者脑原发淋巴瘤的临床特点、治疗和预后情况,并结合文献复习探讨其合理的治疗方式.方法:回顾性分析天津医科大学附属肿瘤医院2000年1月至2009年6月收治的19例无免疫抑制患者脑原发淋巴瘤的临床特征、治疗方式及预后因素,运用SPSS 16.0软件包进行统计分析.结果:19例患者中,男7例,女12例,中位年龄55岁.全组1、3、5年累积生存率分别为78.0%、39.7%和13.2%,中位生存期(MST)22个月;单病灶12例,多病灶7例.病理检查为B细胞来源者占94.7%(18/19),病理类型以弥漫性大细胞淋巴瘤为主.16例患者接受了手术治疗.全组共2例行大剂量甲氨蝶呤化疗.经Log-rank检验:病灶的单发或多发对生存率有显著影响(P=0.001).结论:近年免疫功能正常人群脑原发淋巴瘤发病率上升,疗效不理想,多病灶患者预后不良.化疗在其综合治疗中极为重要,临床采用以HD-MTX为基础的化疗+放疗策略,可提高脑原发淋巴瘤患者的总体生存期.     

Primary central nervous system lymphoma: the role of consolidation treatment after a complete response to high-dose methotrexate-based chemotherapy

BACKGROUND: The most effective treatment for a new diagnosis of primary central nervous system lymphoma is high-dose methotrexate (MTX)-based chemotherapy followed by whole-brain radiation therapy (WBRT). However, this combined modality treatment carries an increased risk of delayed neurotoxicity. For patients who achieve a complete response (CR) after induction that uses high-dose MTX-based chemotherapy, it is not clear if consolidation treatment is necessary. Therefore, a retrospective study was conducted to assess the impact of consolidation treatment after a CR to initial induction chemotherapy on disease control and survival. METHODS: The authors retrospectively analyzed 122 patients who achieved a CR after initial MTX-based chemotherapy. The benefit of consolidation WBRT, high-dose cytarabine (HDAC), or both on failure-free (FFS) and overall survival (OS) was assessed. RESULTS: With a median follow-up of 60 months, FFS was longer in patients who received WBRT plus HDAC as consolidation treatment (P = .03 by univariate analysis); there was no difference in OS observed among patients who received no consolidation treatment, HDAC alone, WBRT plus HDAC, or WBRT alone. Age and Karnofsky performance scale (KPS) were the only independent prognostic factors. Patients who received WBRT alone or in combination with HDAC had higher rates of neurotoxicity. CONCLUSIONS: Consolidation treatment with WBRT, HDAC, or both does not appear to improve survival in patients who achieved a CR with induction MTX-based therapy. Age, KPS, and risk of delayed neurotoxicity must be considered in the choice of consolidation regimens.     

原发性中枢神经系统淋巴瘤的放射治疗进展

原发性中枢神经系统淋巴瘤(PCNSL)是指发生在脑、脊髓、脑膜或眼的罕见侵袭型非霍奇金淋巴瘤,以弥漫大B细胞淋巴瘤占绝大多数,其中又以Non-GCB亚型多见。未经治疗的患者中位生存期仅为3个月,单纯的手术切除肿瘤并没有明显的生存获益。早期单独使用全脑放疗(WBRT),缓解率高,但持续时间短,且延迟性神经系统不良反应是一...     

Primary CNS lymphoma in patients younger than 60: can whole-brain radiotherapy be deferred?

Whole brain radiotherapy (WBRT) has been increasingly omitted as the first treatment of primary central nervous system lymphoma (PCNSL) because of neurotoxicity risks. However, neurotoxicity risks are lower in young (<60 years) patients; deferring WBRT may not be necessary and may compromise disease control. To investigate this question, we report a consecutive series of young (<60 years) PCNSL patients uniformly treated with a response-adjusted approach, with WBRT omitted in patients with chemosensitive disease. Treatment started with induction chemotherapy consisting of methotrexate (3 g/m(2)), CCNU, procarbazine, methylprednisolone and intrathecal methotrexate, cytarabine, and methylprednisolone. Patients achieving complete response (CR) received five additional chemotherapy cycles and no further treatment. Patients with less than CR were treated on an individual basis, typically with WBRT or high-dose chemotherapy (HDC) with stem cell rescue. Sixty-four patients were included (median age: 47; median KPS: 70). Median progression-free survival (PFS) was 12 months; median overall survival (OS) was 63 months (median follow-up: 108 months). Objective response after induction was 87% (CR: 54%; PR: 33%). To date, salvage WBRT has been given to a total of 27 patients and HDC to 29. Neurotoxicity developed in five patients (none in patients treated with chemotherapy only). Deferring WBRT in chemosensitive patients seems to compromise PFS but not OS. Neurotoxicity was reduced but not eliminated, as salvage WBRT was frequently required. HDC and WBRT were effective salvage treatments. As the objective of treatment in this population is a cure, withholding WBRT may not be the best strategy and deserves further investigation. Ongoing studies are investigating whether upfront treatment with HDC can replace WBRT in this setting.     

42例原发性中枢神经系统淋巴瘤患者预后影响因素分析

背景与目的：原发性中枢神经系统淋巴瘤（primary central nervous system lymphoma,PCNSL）是发生在脑、脊髓、脑膜或眼的罕见侵袭型非霍奇金淋巴瘤,无CNS之外的部位累及。PCNSL与其他类型淋巴瘤相比,患者生存期短,预后差,且复发率高,未经治疗的患者的中位生存期仅为3个月。近年来研究发现C-MYC、BCL-2、BCL-6、Ki-67等指标在一定程度上影响PCNSL患者预后。因此,通过分析PCNSL相关蛋白表达、治疗方式及其他临床因素对患者预后的影响, 希望为该病的临床治疗及预后评价进一步积累资料。方法：回顾性分析自2013年6月—2021年5月于大连医科大学附属第二医院治疗的42例经病理学检查明确诊断为原发性中枢神经系统弥漫大B细胞淋巴瘤患者的临床资料,包括性别、年龄、病灶数量、美国东部肿瘤协作组（Eastern Cooperative Oncology Group,ECOG）评分、血清乳酸脱氢酶（lactate dehydrogenase,LDH）、病灶是否累及深部脑组织、治疗方案、病理学Hans分型及C-MYC、BCL-2、BCL-6、Ki-67等生物标志物,结合随访调查,了解患者生存时间及生存状况,应用Kaplan-Meier法及log-rank检验分析影响患者无进展生存期（progression-free survival,PFS）和总生存期（overall survival,OS）的预后相关因素,多因素分析采用COX回归模型。结果：42例PCNSL患者中位发病年龄61岁,男女比例为1.33∶1.00,颅脑增强MRI病灶多呈均匀明显强化。所有患者均接受含有大剂量甲氨蝶呤（high-dose methotrexate,HD-MTX）方案化疗,治疗后评价完全缓解（complete response,CR）20例、部分缓解（partial response,PR）5例,疾病稳定（stable disease,SD）11例,疾病进展（progressive disease,PD）6例。中位PFS为21个月,中位OS为34个月,1年PFS率为63.7%,2年PFS率为47.0%;1年OS率为70.8%,2年OS率为55.6%。单因素分析结果显示,影响PFS的因素是HD-MTX多药联合化疗、鞘内化疗及联合利妥昔单抗。影响OS的因素是ECOG评分≥2、C-MYC（+）、BCL-2及C-MYC双表达、HD-MTX多药联合化疗、鞘内化疗及联合利妥昔单抗。多因素分析结果显示：利妥昔单抗治疗是影响PFS的独立预后因素（P=0.020）,ECOG评分、利妥昔单抗是影响OS的独立预后因素（P=0.007;P=0.046）。与未接受巩固治疗的患者相比,接受巩固治疗患者的中位PFS及OS较高;进一步的亚组分析显示,自体干细胞移植（autologous stem cell transplantation,ASCT）组的中位PFS及OS较全脑放疗（whole brain radiation therapy,WBRT）组高,但差异无统计学意义。结论：PCNSL多发于中老年人,男性多于女性,影像学缺乏特异性。ECOG评分≥2与PCNSL患者较差的OS相关。C-MYC（+）、BCL-2及C-MYC双表达可作为指导危险分层的预后标志物。以HD-MTX为基础的多药联合化疗已经成为PCNSL的首选治疗手段,利妥昔单抗的应用可延长生存期。在全身化疗的基础上,联合局部鞘内化疗可以改善预后。进一步的巩固治疗主要包括ASCT及WBRT,可延长PFS及OS,ASCT可以取得与WBRT相似的疗效,且可避免WBRT的晚期神经毒性,但本研究中因样本量及随访时间的限制,未得出明确的统计学结果。     

Clinical Studies on Primary Central Nervous System Lymphoma： A Report of 31 Cases

OBJECTIVE To analyze the clinical manifestations, neuroimaging and pathological characteristics of primary central nervous system lymphoma （PCNSL） with a normal immunity, and to explore the methods of treatment and diagnosis. METHODS The clinical, laboratory, imaging data and pathological findings and therapeutic efficacy of 31 cases with pathologically proved PCNSL, during a period from July 1995 to June 2006, were analyzed retrospectively. The method of surgery, used in combination with chemotherapy and radiotherapy, was evaluated in 18 cases versus a simple surgical procedure used in 5. Among the total cases, a CHOP regimen was employed in 11 and Teniposide （VM26） plus Semustine （me-CCUN） was used in 7 cases. RESULTS PCNSL had a variety of clinical features, so that its misdiagnosis rate was high. The main clinical findings of PCNSL included intracranial hypertension and （focal） neurologic impairment. No positive result was found in the CSF cellular examination. All of the 31 cases were B-cell lymphoma. Twenty-four of the 31 cases were followed-up, with a follow-up period from 6 to 98 months. The median period of survival of the group who underwent surgery in combination with chemotherapy and radiotherapy was 20 months, while the group with simple surgical therapy was 10 months. CONCLUSION Specific clinical manifestations were usually absent in the patients with PCNSL, giving an uncertain preoperative diagnosis and a poor prognosis. Pathological examination is the only reliable method for a final diagnosis of the disease. The main objective of surgical therapy is to relieve the intracranial hypertension caused by the tumor. Recurrence may occur in a short period following the simple operation. Therefore combined therapy, i.e. surgery plus additional radiotherapy and chemotherapy, should be adopted. This is the key point for extending survival time and improving the quality of life.     

Primäre ZNS-Lymphome

Primary CNS lymphomas (PCNSL) are rare brain tumors comprising only 3% of all primary intracranial neoplasms. The median age at diagnosis ranges between 60 and 65 years. PCNSLs often cause a rapidly progressing psychosyndrome. Magnetic resonance imaging (MRI) reveals multiple or single lesions with homogenous contrast enhancement often in the vicinity of the ventricles. The diagnostic method of choice is stereotactic biopsy. In more than 90% of cases a highly malignant B-cell non-Hodgkin’s lymphoma of the diffuse large-cell type is diagnosed. Patients should be included in clinical studies in order to optimize therapy. Patients younger than 60 years old are expected to be treated curatively and should receive polychemotherapy including systemic high-dose methotrexate (MTX). The role of high-dose chemotherapy with autologous stem cell transplantation as primary treatment has not finally been defined. For patients older than 60 years a curative treatment strategy is not established and in addition, toxicity plays a major role. A MTX-based chemotherapy, e.g. in combination with ifosfamide or temozolomide can be administered. Radiotherapy alone as primary treatment is not recommended. Combination radiotherapy with MTX-based chemotherapy is also not established, demonstrating a high rate of neurotoxicity at late follow-up. In the case of recurrence there are a number of possible treatment options depending on the primary therapy. In Germany, several study groups are organized and the aim of these consortia is optimization of PCNSL therapy.     

原发性中枢神经系统淋巴瘤的临床特征分析

 目的　分析原发性中枢神经系统淋巴瘤（PCNSL）的临床特征,探讨影响疾病的预后因素,并对不同的治疗方案进行评价。方法　回顾性分析初发PCNSL患者的临床资料、治疗经过及随访结果,应用Log-rank进行单因素分析,应用COX回归模型进行生存资料的多因素分析。结果　共收集PCNSL初发病例64例,中位年龄54.9岁,男性多于女性,肿瘤单发62 %（40／64）,深部病变占54 %（33／61）。在我科诊治的具有完整治疗资料的患者26例,其中19例患者初始治疗为单纯化疗,6例为全颅放疗（WBRT）后1个月进行化疗,1例患者初治时仅行WBRT。中位生存时间为17个月,血红蛋白≥9 g／L患者的生存时间长于血红蛋白＜9 g／L患者。年龄>60岁、性别、体能状态、病变部位等因素对预后无明显影响。应用含大剂量甲氨蝶呤（HD-MTX）或替尼泊苷的方案化疗者的预后优于未使用者,化疗联合放疗可能有助于改善患者的预后（χ2＝3.24,P＝0.07）,应用CHOP方案（环磷酰胺、多柔比星、长春新碱、泼尼松）、利妥昔单抗、鞘内注射化疗药物等与预后关系不大;多因素分析提示HD-MTX是影响PCNSL患者生存时间的独立有利因素,颅内病灶部位、病灶的多少、是否联合放化疗等均不是影响预后的独立因素。结论　PCNSL预后较差,应用HD-MTX、替尼泊苷等药物可改善患者的预后,贫血尤其中重度贫血患者预后不良。     

Results of whole-brain radiation as salvage of methotrexate failure for immunocompetent patients with primary CNS lymphoma.

PURPOSE: This study evaluates the efficacy and toxicity of whole-brain radiation therapy (WBRT) as salvage therapy for immunocompetent patients who failed initial high-dose methotrexate for primary CNS lymphoma (PCNSL). PATIENTS AND METHODS: The study cohort included 27 consecutive patients who failed initial high-dose methotrexate and then received salvage WBRT (median dose, 36 Gy). Actuarial survival was measured from the initiation of radiotherapy. RESULTS: Ten patients (37%) achieved a complete radiographic response (CR), and 10 patients (37%) a partial response to WBRT, for a 74% overall radiographic response rate. At the time of maximal response, Karnofsky performance status improved in 12 (44%) of 27 patients and at least stabilized in 67%. Median estimated survival from initiation of WBRT was 10.9 months (range, 0.3 to 63.7 months). The univariate predictor of longer survival was age less than 60 years at the time of WBRT (P = .028). Among patients who survived 4 months, achievement of a CR to WBRT by 4 months (P = .002) predicted longer survival. Late treatment-associated neurotoxicity was diagnosed in four patients (15%) and was significantly associated with total radiation doses greater than 36 Gy (P = .04). No patient treated with daily fractions less than 1.8 Gy developed late neurotoxicity. CONCLUSION: For patients with PCNSL who experience treatment failure with methotrexate, WBRT provides high response rates (74%) and a median survival of 10.9 months. Age less than 60 years and response to WBRT predict post-WBRT survival. Modest rates of late neurotoxicity (15%) were seen and were associated with a total dose greater than 36 Gy.     

原发中枢神经系统淋巴瘤诊疗进展

原发中枢神经系统淋巴瘤是一种少见的中枢神经系统恶性肿瘤,以大剂量甲氨蝶呤为基础方案诱导化疗是目前一线治疗,随后全脑放疗作为巩固治疗.迟发神经认知功能障碍出现,尤其是老年人,使缓解患者是否需要全脑放疗或减量放疗需要进一步明确.利妥昔单抗治疗PCNSL,初步研究表明美罗华可能给患者带来获益,但研究证据水平较低.HDC/ASCT对于治疗复发性或难治性PCNSL虽有疗效但毒副作用较大,临床价值尚存争议.