中枢神经系统预防高剂量甲甲酸和内化疗改善了中枢神经系统复发风险较高的DLBCL患者的生存率
Yuri Miyazawa1, Akihiko Yokohama2, Takuma Ishizaki3
1Department of Hematology, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan. yuri.miyazawa@gunma-u.ac.jp.
International journal of hematology
|August 26, 2025
概括
中枢神经系统 (CNS) 预防使用高剂量的甲状腺素加上肠内化疗 (HD- MTX + IT) 显著改善了患有中枢神经系统复发高风险的扩散性大B细胞淋巴瘤 (DLBCL) 患者的整体存活率. 与其他方法相比,这种联合治疗提供了更好的预后.
科学领域:
- 癌症学
- 血液学
- 临床研究
背景情况:
- 中枢神经系统 (CNS) 复发是扩散型大B细胞淋巴瘤 (DLBCL) 患者的一个重大问题.
- 建议对高危DLBCL患者进行中枢神经系统预防,以防止复发.
- 在DLBCL中最佳的中枢神经系统预防方法仍然是一个研究领域.
研究的目的:
- 评估中枢神经系统预防对高风险DLBCL患者复发率的影响.
- 确定中枢神经系统预防对整体存活时间 (OS) 的影响.
- 确定最有效的中枢神经系统预防方法.
主要方法:
- 对178名中枢神经系统复发高风险的DLBCL患者进行了回顾性分析.
- 患者接受了标准化疗 (R- CHOP或衍生药物),并有或没有中枢神经系统预防作用.
- 中枢神经系统预防方法包括高剂量甲状腺素 (HD-MTX),内化疗 (IT) 或组合 (HD-MTX + IT).
主要成果:
- 两年中枢神经系统复发率为17. 6% 在预防期间与13. 0% 在没有预防期间,没有显著的整体差异.
- 然而,HD-MTX + IT组合显著降低了中枢神经系统复发的风险.
- 与非预防 (58. 0%),单独使用HD- MTX (73. 5%) 或单独使用IT (44. 4%) 相比,五年后的生存状况显著改善.
结论:
- 中枢神经系统预防,特别是HD- MTX + IT的组合,大大改善了中枢神经系统复发高风险的DLBCL患者的预后.
- 在这种患者群体中,HD- MTX + IT被认为是中枢神经系统预防的最佳策略.
- 这种方法提高了高风险DLBCL患者的长期生存结果.
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