{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T20:43:49Z","timestamp":1694637829312},"reference-count":33,"publisher":"Akademiai Kiado Zrt.","issue":"42","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,10,1]]},"abstract":"<jats:p>A primer k\u00f6zponti idegrendszeri lymphoma k\u00fcl\u00f6n entit\u00e1s, amelyet az agy-gerincvel\u0151, szem kiz\u00e1r\u00f3lagos lymphom\u00e1s \u00e9rintetts\u00e9ge \u00e9s a sziszt\u00e9m\u00e1s betegs\u00e9g egyidej\u0171 hi\u00e1nya jellemez. Az extranodalis lymphom\u00e1k k\u00f6z\u00f6tt is ritka, emiatt az optim\u00e1lis kezel\u00e9s nehezen defini\u00e1lhat\u00f3.<jats:italic>C\u00e9lkit\u0171z\u00e9sek:<\/jats:italic>Retrospekt\u00edv elemz\u00e9sben vizsg\u00e1lt\u00e1k oszt\u00e1lyukon 1998\u20132009 k\u00f6z\u00f6tt k\u00f3rism\u00e9zett, kezelt primer \u00e9s\/vagy relab\u00e1lt k\u00f6zponti idegrendszeri lymphom\u00e1s betegeik kombin\u00e1lt (kemo-, radioter\u00e1pia) kezel\u00e9s\u00e9vel nyert adatait.<jats:italic>Betegek \u00e9s m\u00f3dszer:<\/jats:italic>Ezen id\u0151szak alatt (\u00e1tlagos k\u00f6vet\u00e9si id\u0151: 13,2 h\u00f3) 427 \u00fajonnan k\u00f3rism\u00e9zett non-Hodgkin-lymphom\u00e1s beteg k\u00f6z\u00fcl 22-n\u00e9l diagnosztiz\u00e1ltak k\u00f6zponti idegrendszeri lymphom\u00e1t (5,15%, 16 agyi \u00e9s hat gerincvel\u0151t \u00e9rint\u0151\/epiduralis eset). Szignifik\u00e1ns f\u00e9rfit\u00fals\u00falyt (14:8) tal\u00e1ltak, az \u00e9letkori megoszl\u00e1s 34\u201377 (\u00e1tlag: 60,7; medi\u00e1n 64 \u00e9v) volt. Intraocularis lymphom\u00e1s eset\u00fck nem volt, szerzett immundeficienti\u00e1t nem mutattak ki. A k\u00f6zponti idegrendszeri lymphom\u00e1t idegseb\u00e9szi reszekci\u00f3val vagy stereotaxi\u00e1s biopszi\u00e1val nyert mint\u00e1k sz\u00f6vettani vizsg\u00e1lat\u00e1val igazolt\u00e1k. Az agyi lymphom\u00e1sok minden esetben B-sejtes diff\u00faz nagysejtes, m\u00edg a gerincvel\u0151t komprim\u00e1l\u00f3k alacsony malignit\u00e1s\u00fa sz\u00f6vettani csoportba tartoztak.<jats:italic>Kezel\u00e9s:<\/jats:italic>Az epiduralis lymphom\u00e1s betegek \u2013 a follicularis csoport kiv\u00e9tel\u00e9vel \u2013 lok\u00e1lis radioter\u00e1pi\u00e1t, ut\u00f3bbiak sug\u00e1rkezel\u00e9s\u00fck el\u0151tt rituximabot tartalmaz\u00f3 polikemoter\u00e1pi\u00e1t kaptak. Agyi lymphom\u00e1ban nagy d\u00f3zis\u00fa methotrexatot (3 g\/m<jats:sup>2<\/jats:sup>4 \u00f3r\u00e1s cseppinf\u00fazi\u00f3ban) adtak, amelyet 4 hetenk\u00e9nt legal\u00e1bb h\u00e1rom alkalommal megism\u00e9teltek. A methotrexatinf\u00fazi\u00f3 ut\u00e1n 24 \u00f3r\u00e1val leukovorint adtak. A sziszt\u00e9m\u00e1s kezel\u00e9s ut\u00e1n intrathecalis citosztatikus kombin\u00e1ci\u00f3t (cytosin-arabinosid, methotrexat, dexamethason) alkalmaztak. A ter\u00e1pi\u00e1s v\u00e1lasz felm\u00e9r\u00e9se (agyi NMR, koponya-CT, PET\/CT) ut\u00e1n teljes koponyairradi\u00e1ci\u00f3 (30 Gy), residualis lymphom\u00e1n\u00e1l a tumor\u00e1gyra m\u00e9g kieg\u00e9sz\u00edt\u0151 sug\u00e1rkezel\u00e9s t\u00f6rt\u00e9nt. Relapsus\/rezisztens \u00e1llapot eset\u00e9n salvage-kezel\u00e9sk\u00e9nt a methotrexatk\u00far\u00e1t cytosin-arabinosiddal kombin\u00e1lt\u00e1k (3 g\/m<jats:sup>2<\/jats:sup>naponta 2\u00d74 \u00f3r\u00e1s cseppinf\u00fazi\u00f3ban 4 hetente megism\u00e9telve).<jats:italic>Eredm\u00e9nyek:<\/jats:italic>Komplett remisszi\u00f3t kilenc agyi \u00e9s n\u00e9gy epiduralis lymphom\u00e1sn\u00e1l \u00e9rtek el (13\/22; 59,0%), k\u00f6z\u00fcl\u00fck egy relab\u00e1lt, salvage-kezel\u00e9sre sem reag\u00e1lt, elhunyt. Kilenc betegn\u00e9l el\u00e9gtelen ter\u00e1pi\u00e1s v\u00e1laszt l\u00e1ttak, \u00f6t beteg mell\u00e9khat\u00e1sok miatt csak egy-k\u00e9t methotrexatciklust kapott, n\u00e9gy m\u00e1sik beteg pedig a betegs\u00e9g progresszi\u00f3ja miatt halt meg. Az \u00f6sszes\u00edtett t\u00fal\u00e9l\u00e9s agyi lymphom\u00e1sokn\u00e1l 19,5, az epiduralis csoportban 14,1 h\u00f3nap volt, a betegs\u00e9g progresszi\u00f3j\u00e1ig eltelt \u00e1tlagos id\u0151 pedig 4,5 h\u00f3nap (2\u20136,5; medi\u00e1n 4 h\u00f3nap) volt. A k\u00e9t\u00e9ves t\u00fal\u00e9l\u00e9s 50%. Kognit\u00edv funkci\u00f3k javul\u00e1s\u00e1t nyolc esetben \u00e9szlelt\u00e9k. A kemoter\u00e1pia mell\u00e9khat\u00e1sai nagyr\u00e9szt a v\u00e9rk\u00e9pz\u00e9st \u00e9rintett\u00e9k, nyolc betegben k\u00e1rosodott vesem\u0171k\u00f6d\u00e9st, illetve szepszist \u00e9szleltek. A radioter\u00e1pia mell\u00e9khat\u00e1sai elhanyagolhat\u00f3ak voltak.<jats:italic>Konkl\u00fazi\u00f3:<\/jats:italic>A kombin\u00e1lt, el\u0151sz\u00f6r sziszt\u00e9m\u00e1s-intrathecalis polikemoter\u00e1pia, gondos szupport\u00edv kezel\u00e9s, majd az ezt k\u00f6vet\u0151 g\u00f3cd\u00f3zis\u00fa koponyairradi\u00e1ci\u00f3 hat\u00e1sosnak tarthat\u00f3, relapsus\/progresszi\u00f3 eset\u00e9n nagy adag\u00fa cytosin-arabinosid \u00e9s methotrexat kombin\u00e1ci\u00f3ja jav\u00edthatja a kezel\u00e9s sikeress\u00e9g\u00e9t. A kezel\u00e9s befejez\u00e9se ut\u00e1n a PET\/CT negat\u00edv lett \u00f6t beteg\u00fckn\u00e9l, akik az\u00f3ta is betegs\u00e9gmentesek.<\/jats:p>","DOI":"10.1556\/oh.2009.28703","type":"journal-article","created":{"date-parts":[[2009,10,10]],"date-time":"2009-10-10T01:04:14Z","timestamp":1255136654000},"page":"1937-1944","source":"Crossref","is-referenced-by-count":1,"title":["Therapeutic management of central nervous system lymphomas in a single hematological institute"],"prefix":"10.1556","volume":"150","author":[{"given":"J\u00e1nos L\u00e1szl\u00f3","family":"Iv\u00e1nyi","sequence":"first","affiliation":[{"name":"1 Vas Megyei Markusovszky K\u00f3rh\u00e1z Nonprofit Zrt. Hematol\u00f3giai Oszt\u00e1ly Szombathely Markusovszky utca 3. 9700"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c9va","family":"Marton","sequence":"additional","affiliation":[{"name":"1 Vas Megyei Markusovszky K\u00f3rh\u00e1z Nonprofit Zrt. 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Oncol."},{"key":"atypb3","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1002\/cncr.20575","volume":"101","year":"2004","journal-title":"Cancer"},{"key":"atypb4","first-page":"675","volume":"30","year":"1992","journal-title":"Neurosurgery"},{"key":"atypb5","first-page":"282","volume":"22","year":"2003","journal-title":"Clin. Neuropathol."},{"key":"atypb6","doi-asserted-by":"crossref","first-page":"453","DOI":"10.4065\/71.5.453","volume":"71","year":"1996","journal-title":"Mayo Clin. Proc."},{"key":"atypb7","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.ijrobp.2006.01.002","volume":"65","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"atypb8","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1007\/s00417-005-0138-9","volume":"244","year":"2006","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"atypb9","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1097\/00019052-200312000-00005","volume":"16","year":"2003","journal-title":"Curr. Opin. Neurol."},{"key":"atypb10","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1038\/sj.sc.3102124","volume":"46","year":"2008","journal-title":"Spinal Cord."},{"key":"atypb11","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.critrevonc.2007.04.012","volume":"63","year":"2007","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"atypb12","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s11060-006-9276-0","volume":"82","year":"2007","journal-title":"J. Neurooncol."},{"key":"atypb13","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1016\/j.ejca.2006.12.011","volume":"43","year":"2007","journal-title":"Eur. J. Cancer"},{"key":"atypb14","first-page":"95","volume":"6","year":"1975","journal-title":"Acta Neuropathol. Suppl."},{"key":"atypb15","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/oxfordjournals.annonc.a058839","volume":"5","year":"1994","journal-title":"Ann Oncol."},{"key":"atypb16","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1002\/cncr.10357","volume":"94","year":"2002","journal-title":"Cancer"},{"key":"atypb17","doi-asserted-by":"crossref","first-page":"4483","DOI":"10.1182\/blood-2009-01-199877","volume":"113","year":"2009","journal-title":"Blood"},{"key":"atypb18","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/jjco\/hyn027","volume":"38","year":"2008","journal-title":"Jpn. J. Clin. Oncol."},{"key":"atypb19","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1080\/10428190701299564","volume":"48","year":"2007","journal-title":"Leuk. Lymphoma"},{"key":"atypb20","first-page":"177","volume":"128","year":"2004","journal-title":"Br. J. Haematol."},{"key":"atypb21","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1212\/WNL.58.10.1513","volume":"58","year":"2002","journal-title":"Neurology"},{"key":"atypb22","doi-asserted-by":"crossref","first-page":"B113","DOI":"10.1007\/s002770000230","volume":"80","year":"2001","journal-title":"Ann Hematol."},{"key":"atypb23","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/S0090-3019(96)00042-0","volume":"46","year":"1996","journal-title":"Surg. Neurol."},{"key":"atypb24","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1200\/JCO.2006.09.7311","volume":"25","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"atypb25","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.ijrobp.2003.11.001","volume":"59","year":"2004","journal-title":"Int. J. Radiat. Oncol Biol. Phys."},{"key":"atypb26","doi-asserted-by":"crossref","first-page":"3896","DOI":"10.1182\/blood-2008-10-182253","volume":"113","year":"2009","journal-title":"Blood"},{"key":"atypb27","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.5858\/132.11.1830","volume":"132","year":"2008","journal-title":"Arch. Pathol. Lab. Med."},{"key":"atypb28","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3171\/foc.2006.21.2.6","volume":"21","year":"2006","journal-title":"Neurosurg Focus"},{"key":"atypb29","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1080\/1042819021000055057","volume":"44","year":"2003","journal-title":"Leuk Lymphoma"},{"key":"atypb30","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1212\/01.WNL.0000109673.75316.D8","volume":"62","year":"2004","journal-title":"Neurology"},{"key":"atypb31","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.canlet.2007.10.009","volume":"258","year":"2007","journal-title":"Cancer Lett."},{"key":"atypb32","doi-asserted-by":"crossref","first-page":"2922","DOI":"10.1182\/blood.V86.8.2922.2922","volume":"86","year":"1995","journal-title":"Blood"},{"key":"atypb33","doi-asserted-by":"crossref","first-page":"3865","DOI":"10.1200\/JCO.2006.06.2117","volume":"24","year":"2006","journal-title":"J. Clin. 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