弥漫大B细胞淋巴瘤患者继发中枢神经系统侵犯风险评估和预防策略的研究现状

Research status of risk assessment and prevention strategies for secondary central nervous system invasion in patients with diffuse large B-cell lymphoma

弥漫大B细胞淋巴瘤(DLBCL)继发中枢神经系统(CNS)侵犯是一种少见但后果严重的临床事件,该类患者预后差,早期识别及预防尤为重要。CNS-国际预后指数(IPI)是评估DLBCL继发CNS侵犯风险的常用模型,但其敏感度及特异度均不够理想。目前研究者正尝试将分子生物学因素与CNS-IPI结合,旨在更好地识别高危患者,从而指导预防其CNS侵犯。鞘内注射(IT)和全身应用甲氨蝶呤(MTX)是该病的标准预防策略,二者疗效接近,但各有利弊。来那度胺、伊布替尼等新疗法也被证实能有效防治原发性和继发性CNS淋巴瘤(CNSL),这值得进一步探索。笔者拟就DLBCL患者继发CNS侵犯风险评估和预防策略的研究现状进行阐述,旨在为临床医师诊治该病提供参考。

Diffuse large B-cell lymphoma(DLBCL)with secondary central nervous system(CNS)invasion is a rare event with serious clinical consequences,and prognosis of patients is poor.Early identification and prevention are particularly important.The CNS-international prognostic index(IPI)is a commonly used model to assess risk of CNS invasion in patients with DLBCL,but its sensitivity and specificity are not ideal.The combination of molecular biological factors with CNS-IPI is currently under investigation to better identify high-risk patients and thus guide CNS prevention.Intrathecal(IT)and systemic methotrexate(MTX)are the standard prevention strategies with similar efficacy,but each has its advantages and disadvantages.New therapies such as lenalidomide and ibrutinib have also been proven to be effective in prevention and treatment of primary and secondary CNS lymphoma(CNSL),which is worthy of further exploration.This article intends to elaborate on research status of risk assessment and prevention strategies for secondary CNS invasion in patients with DLBCL,aiming to provide a reference for clinicians in the diagnosis and treatment of this disease.