影响医生的裁量权在扩散型大B细胞淋巴瘤中进行中枢神经系统预防的因素:单一机构回顾性研究
Christopher Hino1, Curtis Lacy2, Joel Brothers3
1Department of Internal Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA.
Clinical lymphoma, myeloma & leukemia
|July 23, 2023
概括
内甲状腺素 (IT-MTX) 在预防分散型大B细胞淋巴瘤 (DLBCL) 中的中枢神经系统 (CNS) 复发方面表现出有限的有效性. 高副作用率和高成本需要仔细考虑IT-MTX用于中枢神经系统预防.
科学领域:
- 在瘤学瘤学.
- 血液学 血液学 血液学
- 临床药理学 临床药理学
背景情况:
- 在扩散性大B细胞淋巴瘤 (DLBCL) 中,中枢神经系统 (CNS) 复发是一个重大挑战,预后不佳.
- 中枢神经系统复发的风险分层包括中枢神经系统国际预测指数 (CNS-IPI),但最佳的中枢神经系统预防策略仍在争论中.
- 内甲状腺素 (IT-MTX) 是一种常见的预防方法,但它的疗效和毒性需要进一步评估.
研究的目的:
- 评估IT-MTX在降低DLBCL患者中枢神经系统复发风险方面的有效性.
- 评估与IT-MTX中枢神经系统预防相关的与治疗相关的副作用.
- 在DLBCL管理中确定IT-MTX预防的财务毒性.
主要方法:
- 在2010年1月至2022年8月期间治疗的194名DLBCL患者的回顾性研究.
- 对中枢神经系统预防的IT-MTX疗效,安全概况和财务毒性的评估.
- 分析中枢神经系统复发率,不良事件和相关治疗费用.
主要成果:
- 在中等至高CNS-IPI风险 (CNS-IPI 2-5) 的患者中,IT-MTX没有显著降低中枢神经系统复发的1年风险.
- 在接受IT-MTX的患者中,中枢神经系统复发的中位时间较长 (13.5个月),相比于未接受IT-MTX的患者 (7个月).
- 超过50%的患者报告了不良事件,23.6%的患者经历了2-3级事件;估计的成本从8,059美元到20,140美元不等.
结论:
- IT-MTX在预防DLBCL中中枢神经系统复发方面表现出有限且可能短暂的有效性.
- 与IT-MTX相关的高不良事件率和大量财务成本需要仔细评估风险和收益.
- 临床医生应该明智地考虑IT-MTX预防,权衡其潜在的好处与其重大缺点.
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