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Treatment and prognosis analysis of 205 patients with intracranial primary diffuse large B cell lymphoma
Xiang Miao1,2, Wang Hanyu2, Zhu Dan3, Chen Ye4, Wang Jijin2, Shao Han2, Xia Yunfei2, Zhang Yujing2
1Department of Oncology, Mianyang Central Hospital, Mianyang 621099, China; 2Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; 3Department of Ultrasound, Meishan People's Hospital, Meishan 620010,China; 4Department of Abdominal Oncology, West China Hospital of Sichuan University, Chengdu 610041, China
AbstractObjective To analyze the clinical efficacy and prognostic factors of intracranial primary diffuse large B-cell lymphoma (DLBCL). Methods Clinical data of 205 patients pathologically diagnosed with intracranial primary DLBCL at Sun Yat-sen University Cancer center from March 2001 to September 2020 were retrospectively analyzed. Among them, 101 patients were male and 104 female, the median age was 54 years old. Non-germinal center B cell (GCB) subtype accounted for 74.1%(126/170). A total of 177 patients received high-dose methotrexate (HD-MTX) and 91 patients received rituximab. After induction chemotherapy, 59 patients (30.4%) achieved complete response (CR), 112 patients (57.7%) achieved partial response (PR) or stable disease (SD). A total of 83 patients received consolidation or salvage radiotherapy, and only 14 patients received autologous stem cell transplantation (ASCT). The influence of pathological type, chemotherapy, rituximab treatment, radiotherapy and radiotherapy mode, ASCT and other factors on the overall survival (OS) and progression free survival (PFS) was evaluated. The survival rate was calculated by Kaplan-Meier method. Univariate prognostic analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by COX model. Results The median follow-up time was 34 months. The 5-year OS and PFS rates were 55.6% and 44.2%, respectively. GCB subtype, chemotherapy with HD-MTX, rituximab treatment, remission status after induction chemotherapy, and radiotherapy were favorable prognostic factors for OS or PFS, in which the last three were the independent prognostic factors. Consolidation radiotherapy in patients who obtained CR after induction chemotherapy did not significantly improve survival, while salvage radiotherapy in patients who achieved PR/SD after induction chemotherapy significantly improved both OS and PFS(both P<0.01). Consolidation radiotherapy showed no significant survival difference compared with consolidation ASCT. Conclusions The non-GCB subtype of intracranial primary DLBCL is related to poor prognosis. The addition of rituximab to HD-MTX based induction chemotherapy can improve survival. Radiotherapy is still an important treatment for intracranial primary DLBCL, and there are limitations of ASCT in practical clinical application.
Fund:Beijing Bethune Charitable Foundation (B19136DT); NHC Key Laboratory of Nuclear Technology Medical Transformation (Mianyang Central Hospital) (2021HYX011)
Xiang Miao,Wang Hanyu,Zhu Dan et al. Treatment and prognosis analysis of 205 patients with intracranial primary diffuse large B cell lymphoma[J]. Chinese Journal of Radiation Oncology, 2023, 32(4): 307-312.
Xiang Miao,Wang Hanyu,Zhu Dan et al. Treatment and prognosis analysis of 205 patients with intracranial primary diffuse large B cell lymphoma[J]. Chinese Journal of Radiation Oncology, 2023, 32(4): 307-312.
[1] Villano JL, Koshy M, Shaikh H, et al.Age, gender, and racial differences in incidence and survival in primary CNS lymphoma[J]. Br J Cancer, 2011,105(9):1414-1418. DOI: 10.1038/bjc.2011.357. [2] Swerdlow SH, Campo E, Pileri SA, et al.The 2016 revision of the World Health Organization classification of lymphoid neoplasms[J]. Blood, 2016,127(20):2375-2390. DOI: 10.1182/blood-2016-01-643569. [3] Abrey LE, Batchelor TT, Ferreri AJ, et al.Report of an international workshop to standardize baseline evaluation and response criteria for primary CNS lymphoma[J]. J Clin Oncol, 2005,23(22):5034-5043. DOI: 10.1200/JCO.2005.13.524. [4] 孟凡军, 郭建贵, 林尤恩, 等. 71例原发颅内中枢神经系统DLBCL预后分析[J].中华放射肿瘤学杂志,2017,26(8):909-913. DOI: 10.3760/cma.j.issn.1004-4221.2017.08.012. Meng FJ, Guo JG, Lin YE, et al.Prognostic analysis of 71 patients with primary central nervous system diffuse large B-cell lymphoma[J]. Chin J Radiat Oncol,2017,26(8):909-913. DOI: 10.3760/cma.j.issn.1004-4221.2017.08.012. [5] Schaff LR, Grommes C.Update on novel therapeutics for primary CNS lymphoma[J]. Cancers (Basel), 2021,13(21):5372. DOI: 10.3390/cancers13215372. [6] Bellinzona M, Roser F, Ostertag H, et al.Surgical removal of primary central nervous system lymphomas (PCNSL) presenting as space occupying lesions: a series of 33 cases[J]. Eur J Surg Oncol, 2005,31(1):100-105. DOI: 10.1016/j.ejso.2004.10.002. [7] Alnahhas I, Malkin M.Journal Club: Randomized phase III study of whole-brain radiotherapy for primary CNS lymphoma[J]. Neurology, 2015,85(24): e187-189. DOI: 10.1212/WNL.0000000000002213. [8] Nabors LB, Portnow J, Ahluwalia M, et al.Central nervous system cancers, version 3.2020, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2020,18(11):1537-1570. DOI: 10.6004/jnccn.2020.0052. [9] Batchelor T, Carson K, O'Neill A, et al. Treatment of primary CNS lymphoma with methotrexate and deferred radiotherapy: a report of NABTT 96-07[J]. J Clin Oncol, 2003,21(6):1044-1049. DOI: 10.1200/JCO.2003.03.036. [10] Shah GD, Yahalom J, Correa DD, et al.Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma[J]. J Clin Oncol, 2007,25(30):4730-4735. DOI: 10.1200/JCO.2007.12.5062. [11] Birnbaum T, Stadler EA, von Baumgarten L, et al. Rituximab significantly improves complete response rate in patients with primary CNS lymphoma[J]. J Neurooncol, 2012,109(2):285-291. DOI: 10.1007/s11060-012-0891-7. [12] Holdhoff M, Ambady P, Abdelaziz A, et al.High-dose methotrexate with or without rituximab in newly diagnosed primary CNS lymphoma[J]. Neurology, 2014,83(3):235-239. DOI: 10.1212/WNL.0000000000000593. [13] Ferreri AJ, Verona C, Politi LS, et al.Consolidation radiotherapy in primary central nervous system lymphomas: impact on outcome of different fields and doses in patients in complete remission after upfront chemotherapy[J]. Int J Radiat Oncol Biol Phys, 2011,80(1):169-175. DOI: 10.1016/j.ijrobp.2010.01.066. [14] Thiel E, Korfel A, Martus P, et al.High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma (G-PCNSL-SG-1): a phase 3, randomised, non-inferiority trial[J]. Lancet Oncol, 2010,11(11):1036-1047. DOI: 10.1016/S1470-2045(10)70229-1. [15] Harder H, Holtel H, Bromberg JE, et al.Cognitive status and quality of life after treatment for primary CNS lymphoma[J]. Neurology, 2004,62(4):544-547. DOI: 10.1212/wnl.62.4.544. [16] Illerhaus G, Marks R, Ihorst G, et al.High-dose chemotherapy with autologous stem-cell transplantation and hyperfractionated radiotherapy as first-line treatment of primary CNS lymphoma[J]. J Clin Oncol, 2006,24(24):3865-3870. DOI: 10.1200/JCO.2006.06.2117. [17] Illerhaus G, Kasenda B, Ihorst G, et al.High-dose chemotherapy with autologous haemopoietic stem cell transplantation for newly diagnosed primary CNS lymphoma: a prospective, single-arm, phase 2 trial[J]. Lancet Haematol, 2016,3(8):e388-397. DOI: 10.1016/S2352-3026(16)30050-3. [18] Omuro A, Correa DD, DeAngelis LM, et al. R-MPV followed by high-dose chemotherapy with TBC and autologous stem-cell transplant for newly diagnosed primary CNS lymphoma[J]. Blood, 2015,125(9):1403-1410. DOI: 10.1182/blood-2014-10-604561. [19] Houillier C, Taillandier L, Dureau S, et al.Radiotherapy or autologous stem-cell transplantation for primary CNS lymphoma in patients 60 years of age and younger: results of the intergroup ANOCEF-GOELAMS randomized phase II PRECIS study[J]. J Clin Oncol, 2019,37(10):823-833. DOI: 10.1200/JCO.18.00306.
2023, Vol. 32 
