Primary Central Nervous System B-cell Lymphoma Analysis Of Clinical Features And Prognostic Factors

Objective:To explore the clinical features,curative effects and prognostic factors of primary central nervous system B-cell lymphoma,and provide help for early diagnosis of the disease,accurate prognosis and selection of the best treatment.Methods:A retrospective analysis of 12 patients with primary central nervous system lymphoma admitted to the Second Affiliated Hospital of Anhui Medical University from January 2015 to July 2021.The age,clinical manifestations,hematology,cerebrospinal fluid,pathology,and imaging of the patients were collected.General data such as medical examinations and treatment plans were used to analyze and evaluate the prognostic stratification,clinical efficacy and survival time of patients.The survival time of the patients,age of onset,ECOG score,number of lesions,protein content in cerebrospinal fluid,presence or absence of cerebrospinal fluid involvement,Hans classification,radiotherapy,methotrexate dose,intrathecal injection or not were statistically analyzed to preliminarily explore the factors that may be related to the prognosis.Results:1)The first symptoms of 12 patients were headache,dizziness,limb weakness,hemiplegia,unsteady walking,etc.;2)Imaging results: 7 patients had single lesions and 5 patients had multiple lesions.The most common involved site was: forehead lobe,paraventricular,parietal lobe,corpus callosum;3)Pathological examination: 5 cases were diffuse large B-cell lymphoma,7 cases were high-grade B-cell lymphoma,Hans classification suggested germinal center origin in 4cases and non-germinal in 8 cases Center source;8 cases with Ki-67（+）≥90%,4 cases with Ki-67（+）between 80% and 90%;4)Treatment: All 12 patients underwent tumor resection or biopsy.The main induction chemotherapy regimen was High-dose methotrexate,some of which were used in combination with rituximab,cytarabine,temozolomide,lenalidomide and other single or multiple drugs.5 patients received whole brain radiotherapy,6 patients received lumbar puncture and intrathecal Injection.After complete remission,oral lenalidomide or lenalidomide combined with rituximab was given as maintenance therapy.5)The efficacy evaluation of the 12 patients at the end of the study was as follows: 4patients had complete remission（CR）,1 patient had stable disease（SD）,and 7 patients had progressive disease（PD）.Among them,2 patients with PD died from persistent disease progression during induction therapy.The condition of 5 patients improved after treatment,and the disease progressed during the consolidation and maintenance process using the original induction regimen.The condition of 3 patients maintained with lenalidomide was well controlled.（2）Statistical analysis showed that survival time was related to intrathecal injection（P< 0.05）,age,number of lesions,protein content of cerebrospinal fluid,lymphoma cerebrospinal fluid invasion,Hans classification,radiotherapy,methotrexate dose,etc.The difference in survival time was not statistically significant,and regular intrathecal injections prolonged survival time in PCNSL patients.Conclusion:（1）The clinical manifestations of primary central nervous system lymphoma（PCNSL）are complex and diverse,with strong invasiveness.Intrathecal injection is beneficial to prolong the survival time of PCNSL patients.（2）Lenalidomide can be considered as an important means of maintenance therapy for elderly PCNSL patients,but it still needs to be confirmed by prospective studies with a larger sample size.