剂量调整R-MAD方案治疗老年原发性中枢神经系统淋巴瘤疗效观察  

Efficacy and safety of the dose-adjusted R-MAD regimen in the treatment of elderly primary central nervous system lymphoma patients

作　　者：陈悦丹 孙雪飞[1] 王亚明[4] 孙胜军[2] 季楠[3] 刘元波[1] CHEN Yue-dan;SUN Xue-fei;WANG Yaming;SUN Sheng-jun;JI Nan;LIU Yuan-bo(Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Xuanxvu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京天坛医院血液科,北京100070 [2]首都医科大学附属北京天坛医院放射科,北京100070 [3]首都医科大学附属北京天坛医院神经外科,北京100070 [4]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华肿瘤防治杂志》2021年第20期1573-1577,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：首都卫生发展科研专项(2020-2-2049)。

摘　　要：目的探讨利妥昔单抗联合剂量调整的R-MAD方案(甲氨蝶呤+阿糖胞苷+地塞米松)治疗初治老年原发性中枢神经系统淋巴瘤(PCNSL)患者的疗效及安全性。方法回顾性分析2014-10-01-2019-10-01首都医科大学附属北京天坛医院血液科收治的54例≥65岁老年PCNSL患者的临床资料。患者均给予利妥昔单抗(375 mg/m^(2),d_(0))、甲氨蝶呤(1.5~3.5 g/m^(2),占,根据肾小球滤过率调整药物剂量)、阿糖胞苷(0.5 g/m^(2),d_(2))及地塞米松(10 mg/d,d_(1)〜d_(3)),21 d为1个周期,治疗3~6个周期。评价疗效和不良反应,以完全缓解和部分缓解作为治疗有效标准。采用Kaplan-Meier法绘制生存曲线,分析患者1年无进展生存率和总生存率。结果54例患者中完全缓解27例(50.0%),部分缓解14例(25.9%),疾病稳定5例(9.3%),疾病进展8例(14.8%),总有效率为75.9%(41/54)。中位无进展生存期为11个月(95%CI为6.7〜15.3),中位总生存期为30个月(95%CI为24.8-35.2)。1年无进展生存率与总生存率分别为47.3%和82.4%。不良反应以骨髓抑制为主,13%(7/54)的患者出现3~4级血液学不良反应;无4级非血液学不良反应,3例3级非血液学不良反应均为肺炎,治疗后恢复良好;未发生治疗相关死亡。结论利妥昔单抗联合剂量调整的甲氨蝶呤、阿糖胞苷和地塞米松治疗初治老年PCNSL疗效较好,安全性高。Objective To evaluate the effectiveness and safety of R-MAD regimen(rituximab combined with dose-adjusted methotrexate,cytarabine and dexamethasone)in the treatment of elderly patients with newly diagnosed primary central nervous system lymphoma(PCNSL).Methods The clinical data of 54 elderly PCNSL patients aged 65 or older admitted to Department of Hematology,Beijing Tiantan Hospital,Capital Medical University from October 1,2014 to October 1,2019 were analyzed retrospectively.All patients received rituximab(375 mg/m^(2),d_(0)),dose-adjusted methotrexate(1.5-3.5 g/m^(2),d_(1),dosage adjustment according to glomerular filtration rate),cytarabine(0.5 g/m^(2),d_(2))and dexamethasone(10 mg/d,d_(1)-d_(3))for chemotherapy.Every 21 days were considered as a course of treatment,and the patients were treated for 3-6 courses.The therapeutic effect of patients was evaluated according to the therapeutic evaluation criteria formulated by the in ternational PCNSL collaborative group in 2005.Complete remission or partial remission was regarded as effective.Adverse drug reactions were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events(version 4.02).Kaplan-Meier method was used to draw the survival curve.The 1-year progression free survival rate and 1-year overall survival rate were evaluated.Results Of 54 patients,27 patients had complete remission(50.0%),14 patients had partial remission(25.9%),5 patients had stable disease(9.3%),and 8 patients had disease progression(14.8%).The total effective rate was 75.9%(41/54).The median progression-free survival was 11 months(95%CI:6.7-15.3),and the median overall survival was 30 months(95%CI:24.8-35.2).The 1-year progression-free survival rate and overall survival rate were 47.3%and 82.4%,respectively.The main adverse reaction was bone marrow suppression,and 13%(7/54)of patients had grade 3 to 4 hematological adverse reactions.There were no grade 4 non-hematological adverse reactions,and 3 cases were observed with grade 3 non-hematologica

关 键 词：原发性中枢神经系统淋巴瘤 老年人 化学治疗 甲氨蝶呤 利妥昔单抗 阿糖胞苷 

分 类 号：R739.4[医药卫生—肿瘤]