大剂量甲氨喋呤联合利妥昔单克隆抗体治疗原发性中枢神经系统淋巴瘤的疗效观察

Curative Efficacy of High Dose MTX Combined with Rituxan for Treatment Primary CNS Lymphoma

目的:探讨大剂量甲氨喋呤联合利妥昔单克隆抗体治疗原发性中枢神经系统淋巴瘤(PCNSL)的疗效。方法:选取我科收治的100例原发性中枢神经系统淋巴瘤患者并将他们分为靶向治疗组和传统治疗组,各组50例。靶向治疗组所采用的治疗方法为大剂量甲氨喋呤联合利妥昔单克隆抗体治疗,传统治疗组所采用的治疗方法为传统的大剂量甲氨喋呤与全脑放疗相结合治疗,进行相关的影像学检查,统计两组的一般临床资料、影像学资料、随访结果以及生存时间并进行比较与分析。结果:在靶向治疗组中,完全缓解的病例有33例,病情稳定的病例有9例,部分缓解的有5例,病情有进展的有3例;而在传统治疗组中,完全缓解的病例有29例,病情稳定的病例有5例,部分缓解的有11例,病情进展的有5例。靶向治疗组与传统治疗组的中位无进展生存时间分别为28个月和11个月。结论:临床上首选治疗PCNSL的方案为大剂量甲氨喋呤化疗,与全脑放疗相结合进行治疗,具有一定的疗效,但不良反应较大,有很大可能会出现晚期神经毒性反应。大剂量甲氨喋呤联合利妥昔单克隆抗体治疗PCNSL,疗效较高,不良反应较少,副作用较小,在治疗老年PCNSL患者方面也具有更积极的价值。

Objective：To explore the curative efficacy of methotrexate（MTX） combined with rituxan for treating patients with primary central nervous system（ CNS） lymphoma. Methods： One hundred patients with primary CNS lymphoma in our hospital were randomly divided into targeted treatment group（50 cases） and traditional treatment group（50 cases）. Targeted treatment group adopted the therapy of high-dose methotrexate combined with rituxan,the traditional treatment group adopted the high-dose methotrexate combined with whole brain radiotherapy. The results of relevant imaging examination,clinical data,imaging,follow-up and the survival time were analysed and compared between these 2 groups. Results： In the targeted therapy group,there were 33 cases in CR,9 cases were in stable condition,and 5 cases were in partial response,and 3 cases in the progressive stage. In the group of traditional treatment group,29 cases reached complete remission,5 cases were in stable condition,11 cases were in partial response,and 5 cases were in the progressive stage. In the targeted treatment group and traditional treatment group,the median progression-free survival time was 28 and 11 months,respectively. Conclusion： The first choice for treatment scheme of PCNSL is high-dose methotrexate chemotherapy combined with whole brain radiotherapy,that showed a certain curative effect,but the adverse reactions are larger,and a big late neuro toxic reaction may occur,while high-dose methotrexate combined PCNSL rituxan treatment shows high curative effect,less adverse reaction and low side effects. This treatment also has a more positive value for the elderly patients with PCNSL.