RMT方案序贯来那度胺维持治疗老年初治原发中枢神经系统淋巴瘤疗效分析  

Clinical Outcomes of RMT Induction and Lenalidomide Maintenance in the Elderly Patients with Newly Diagnosed Primary Central Nervous System Lymphoma

作　　者：曲双[1] 廖丽昇[1] 郑志海[1] 谢颖[1] 陈为民[1] 陈碧云[1] QU Shuang;LIAO Li-sheng;ZHENG Zhi-hai;XIE Ying;CHEN Wei-min;CHEN Bi-yun(Department of Hematology,Fujian Provincial Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院血液科,福建福州350001

出　　处：《海峡药学》2022年第11期103-106,共4页Strait Pharmaceutical Journal

基　　金：福建省卫生计生中青年骨干人才培养项目(编号:2016-ZQN-11)、中国抗癌协会淋巴瘤科研基金资助(编号:CORP-117)。

摘　　要：目的本文旨在探索RMT方案序贯来那度胺维持治疗老年初治原发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年6月~2021年6月我院收治的28例老年(年龄≥65岁)初治原发中枢神经系统淋巴瘤患者临床资料。接受RMT方案(利妥昔单抗375 mg/m^(2),d0;大剂量甲氨蝶呤MTX 5 g/m^(2),d1;替莫唑胺150 mg/m^(2)d5-9,每21天为1个疗程),6疗程后序贯来那度胺维持治疗。评价疗效及不良反应。结果19例达完全缓解,1例达部分缓解,3例疾病稳定,5例疾病进展。总反应率为71.4%,其中完全缓解率67.9%,部分缓解率3.6%。中位随访30个月(9~60个月),中位无进展生存时间(PFS)为23个月,中位总生存时间为54个月。4年累计总生存率65.2%,无进展生存率为47.8%。单因素分析发现,脑脊液蛋白水平、血LDH及体能等与预后不良相关。Cox回归分析结果显示血LDH升高是独立的危险因素。入组患者无因治疗相关不良事件中断治疗。结论RMT方案序贯来那度胺维持治疗老年初治PCNSL患者近期及远期疗效较好,不良反应轻,安全性好,是诱导或挽救治疗的选择,将来需进一步开展大样本的前瞻性研究评估。OBJECTIVE To analyze clinical outcomes of RMT induction and lenalidomide maintenance in the elderly patients with newly diagnosed primary central nervous system lymphoma(PCNSL).METHODS From June 2014 to June 2021,the data of 28 PCNSL patients were analyzed retrospectively.The patients were treated with rituximab(375 mg/m^(2))administered on day 0,MTX(5 g/m^(2))on day 1 and TMZ(150 mg/m^(2))from day 5 to day 9.They received six cycles of chemotherapy,repeated every 3 weeks.The induction therapy was followed by lenalidomide maintenance.The efficacy and toxicity of the regimen were analyzed.RESULTS Complete remission rate was 67.9%.Partial remission rate was 3.6%.The median follow-up for surviving patients was 30 months(9-60 months).The median overall survival(OS)was 54 months.The median progression free survival(PFS)was 23 months.The 4-year OS rates were 65.2%and 4-year PFS were 46.7%.Multivariate Cox regression analysis indicated that high IPI score was independently associated with poor prognosis.CONCLUSION Our results suggest that RMT followed by lenalidomide maintenance may be a safe and effective regimen for the elderly patients with newly diagnosed PCNSL.Further prospective trials are needed to confirm our results.

关 键 词：淋巴瘤 中枢神经系统 来那度胺 

分 类 号：R969.4[医药卫生—药理学]