对于一大群初级中枢神经系统淋巴瘤患者来说,不断变化的整合模式和结果
Kathryn R Tringale1,2, Michael Scordo3, Joachim Yahalom1
1Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
Blood advances
|August 21, 2024
概括
主要中枢神经系统淋巴瘤 (PCNSL) 的整合策略在几十年内发展. 虽然非骨髓缩化疗 (NMC) 的使用增加了,但降低剂量的全脑放射治疗 (RD-WBRT) 仍然是为特定患者提供可行的选择.
科学领域:
- 神经瘤学神经瘤学
- 血液学恶性瘤是什么
- 癌症治疗及其结果
背景情况:
- 初级中枢神经系统淋巴瘤 (PCNSL) 的管理包括化学免疫治疗后的整合疗法.
- 巩固的选择包括降低剂量全脑放射治疗 (RD-WBRT),非骨髓衰变化疗法 (NMC) 和自身造血细胞移植 (AHCT).
- 这些合并策略的比较结果数据有限.
研究的目的:
- 为了比较PCNSL不同整合策略的结果.
- 分析随着时间的推移,整合疗法使用的趋势.
- 确定与治疗选择和患者存活率相关的因素.
主要方法:
- 在1983年至2020年期间治疗的559名PCNSL患者的回顾性分析.
- 按十年分层和纪念斯隆·凯特林癌症中心的递归分区分析 (RPA) 类.
- 使用比例危险模型分析无进展生存 (PFS) 和整体生存 (OS).
主要成果:
- 从20世纪90年代到2010年代,WBRT的使用减少,而AHCT和NMC的使用显著增加.
- 在RPA类2患者中,接受NMC的可能性更高.
- 在整合策略中没有观察到显著的调整生存差异,尽管NMC在某些RPA类中显示出相比RD-WBRT的PFS较不有利的趋势.
结论:
- 对于PCNSL的巩固策略已经转向使用NMC而不是RD-WBRT的增加.
- 尽管趋势发生了变化,但没有任何一项整合策略显示出更高的调整后生存效益.
- 对于无法接受AHCT的患者,可以考虑RD-WBRT,而NMC的使用正在增加,尽管潜在的PFS权衡.
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