弥漫性大B细胞淋巴瘤继发中枢神经系统侵犯的诊疗进展

Progress in the diagnosis and treatment of secondary central nervous system involvement in diffuse large B-cell lymphoma

弥漫性大B细胞淋巴瘤(DLBCL)继发中枢神经系统(CNS)侵犯是一种严重的临床并发症,发生率较低但预后通常很差。在高危因素鉴定方面需结合临床与分子生物学。治疗方案现包括以大剂量甲氨蝶呤(HD-MTX)为基础的化疗加利妥昔单抗(R)诱导治疗和强化化疗后自体造血干细胞移植(ASCT)或嵌合抗原受体T细胞免疫疗法(CAR-T),其中HD-MTX作用仍有争议,伊布替尼等酪氨酸激酶(BTK)抑制剂的治疗值得探讨。本文将讨论DLBCL继发CNS的高危因素、诊断及治疗。

Secondary central nervous system(CNS)involvement in diffuse large B-cell lymphoma(DLBCL)is a serious clinical complication,with a low incidence but usually poor prognosis.In the identification of high-risk factors,it is necessary to combine clinical and molecular biology.The treatment plan now includes the induction treatment of chemotherapy based on high-dose methotrexate(HD-MTX)with rituximab(R)and autologous stem cell transplantation(ASCT)or chimeric antigen receptor T-cell immunotherapy(CAR-T)after intensive chemotherapy.The role of HD-MTX is still controversial,and the treatment of Ibrutinib and other Bruton tyrosine kinase(BTK)inhibitors is worth exploring.In this review,the high-risk factors,diagnosis,and treatment of secondary CNS involvement in DLBCL will be discussed.