原发性中枢神经系统淋巴瘤（PCNSL）诱导化学免疫治疗后的巩固策略包括全脑放疗（≤24Gy减量剂量[RD]、>24Gy标准剂量[SD] WBRT）和阿糖胞苷、非清髓性化疗（NMC）、或自体造血细胞移植（AHCT）；然而，缺乏可比较的结果。 1983 年至 2020 年的 PCNSL 结果按十年和 MSKCC 递归分区分析 (RPA) 类别进行分层。通过多项逻辑回归分析临床人口统计学与巩固的关联。通过巩固的比例风险对无进展生存期 (PFS) 和总生存期 (OS) 进行分析。在 559 名患者中，385 名 (69%) 接受了巩固治疗。中位随访时间和 OS 分别为 7.4 年和 5.7 年。 WBRT 使用率下降（1990 年代为 61%，2010 年代为 12%），而 AHCT（1990 年代为 4%，2010 年代为 32%）和 NMC（1990 年代为 27%，2010 年代为 52%）上升。与 RPA 1（年龄<50）相比，RPA 2（年龄≥50，KPS≥70）更有可能接受 NMC。对诱导有部分反应的患者接受 AHCT 的可能性较小（OR 0.36，p=0.02）。在 351 名对巩固治疗完全缓解的患者中，只有接受 R-MPV 诱导与 PFS 改善相关（HR 0.5，p=0.006）。在 RPA 1 中，AHCT 或 RD-WBRT 未达到中位 PFS 和 OS，而 NMC 后分别为 2.5 和 13.0 年。在 RPA 3 级 (KPS<70) 中，RD-WBRT 后的中位 PFS 和 OS 分别为 4.6 年和 10 年，而 NMC 后分别为 1.7 年和 4.4 年。不同整合策略中未发现显着的调整后生存差异。尽管有 PFS 较差的趋势，但 NMC 越来越多地用来代替 RD-WBRT。不适合 AHCT 的患者可以考虑 RD-WBRT。版权所有 © 2024 美国血液学会。

Consolidation strategies for primary central nervous system lymphoma (PCNSL) after induction chemoimmunotherapy include whole-brain radiotherapy (≤24Gy reduced-dose [RD], >24Gy standard-dose [SD] WBRT) and cytarabine, non-myeloablative chemotherapy (NMC), or autologous hematopoietic cell transplantation (AHCT); however, comparative outcomes are lacking. PCNSL outcomes from 1983-2020 were stratified by decade and MSKCC recursive partitioning analysis (RPA) class. Clinicodemographic associations with consolidation were analyzed by multinomial logistic regression. Progression-free (PFS) and overall survival (OS) were analyzed by proportional hazards from consolidation. Of 559 patients, 385 (69%) were consolidated. Median follow-up and OS were 7.4 and 5.7 years, respectively. WBRT use declined (61% in 1990s vs. 12% in 2010s), while AHCT (4% in 1990s vs. 32% in 2010s) and NMC (27% in 1990s vs. 52% in 2010s) rose. Compared to RPA 1 (age<50), RPA 2 (age≥50, KPS≥70) was more likely to receive NMC. Those with partial response to induction were less likely to receive AHCT (OR 0.36, p=0.02). Among 351 with complete response to consolidation, only receipt of R-MPV induction was associated with improved PFS (HR 0.5, p=0.006). Among RPA 1, median PFS and OS were not reached for AHCT or RD-WBRT, vs. 2.5 and 13.0 years, respectively, after NMC. Among RPA class 3 (KPS<70), median PFS and OS post-RD-WBRT were 4.6 and 10 years, respectively, vs. 1.7 and 4.4 years post-NMC. No significant adjusted survival differences were seen across consolidation strategies. NMC is increasingly used in lieu of RD-WBRT despite a trend toward less favorable PFS. RD-WBRT can be considered in patients ineligible for AHCT.Copyright © 2024 American Society of Hematology.