S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) Theses (Master's Degree_의학과)
Prognostic factors in primary diffuse large B cell lymphoma of the central nervous system treated with methotrexate, vincristine, and procarbazine
메토트렉세이트, 빈크리스틴, 프로카바진으로 치료 받은 중추신경계 원발성 미만성 거대 B 세포 림프종의 예후 인자
- 허 대 석
- 의과대학 의학과
- Issue Date
- 서울대학교 대학원
- 학위논문 (석사)-- 서울대학교 대학원 : 의학과 중개의학전공, 2016. 8. 허대석.
- Introduction: Although several prognostic models of primary diffuse large B cell
lymphoma (DLBCL) of the central nervous system (CNS) have been proposed, the
results of recent studies were not consistent. Therefore, we analyzed prognostic
factors in patients with primary DLBCL of the CNS who received methotrexate,
vincristine, and procarbazine (MVP) as an initial treatment.
Materials and methods: Sixty-nine immunocompetent patients who were newly
diagnosed with primary DLBCL of the CNS received 4 to 6 cycles of MVP between
February 2000 and September 2014 at Seoul National University Hospital.
Prognostic factors that had an influence on survival were analyzed. The outcomes of
additional treatment such as rituximab or radiotherapy (RT) were also analyzed in
Results: The median age was 59.2 (range, 25.5–84.3), and 41 (59.4%) patients were
men. Twenty patients were treated with rituximab plus MVP, and 40 patients
received RT. After a median of 5 cycles, 47 (68.1%) patients achieved complete
remission (CR). A total of 28 (40.6%) patients had disease progression. Patients
with a poor performance status showed a low CR rate (ECOG ≥2 vs. ECOG 0-1,
32.3 vs. 67.7%, respectively, P = 0.059). Treatment with rituximab was associated
with a high CR rate (P = 0.055). Age >65 years (hazard ratio (HR)
confidence interval (CI)
1.62–8.75, P = 0.002) and RT (HR
0.287, 95% CI
0.71, P = 0.007) were prognostic factors for overall survival (OS) and progressionfree
survival (PFS), respectively. Rituximab therapy was associated with poor OS in
patients with superficial lesions (5-year OS, 59.7 vs. 33.3%, P = 0.034).
Conclusions: Age ≤65 years was the only favorable prognostic factor for OS. RT
was associated with prolonged PFS. The addition of rituximab was not proven to
provide benefits in OS or PFS.