Hamlin Paul A, Zelenetz Andrew D, Kewalramani Tarun, Qin Jing, Satagopan Jaya M, Verbel David, Noy Ariela, Portlock Carol S, Straus David J, Yahalom Joachim, Nimer Stephen D, Moskowitz Craig H
Lymphoma and Hematology Services, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Box 350, 1275 York Ave, New York, NY, 10021.
Blood. 2003 Sep 15;102(6):1989-96. doi: 10.1182/blood-2002-12-3837. Epub 2003 Apr 3.
Second-line chemotherapy followed by high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) cures less than half of the patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Prognostic models capable of predicting outcome are essential. In 3 sequential clinical trials, conducted from January 1993 to August 2000, we treated 150 patients with relapsed or primary refractory DLBCL with ifosfamide, carboplatin, and etoposide (ICE) chemotherapy followed by HDT/ASCT for patients with chemosensitive disease. We evaluated the age-adjusted International Prognostic Index at the initiation of second-line therapy (sAAIPI) as a predictor of progression-free survival (PFS) and overall survival (OS). At a median follow-up of 4 years, the PFS and OS are 28% and 34% by intention to treat and 39% and 45% for only those patients with chemosensitive disease. Three risk groups with different PFS and OS were identified by the sAAIPI: low risk (0 factors), 70% and 74%; intermediate risk (1 factor), 39% and 49%; and high risk (2 or 3 factors), 16% and 18% (P <.001 for both PFS and OS). The sAAIPI also predicts the PFS and OS for patients with ICEchemosensitive disease: low risk, 69% and 83%; intermediate risk, 46% and 55%; and high risk, 25% and 26% (P <.001 PFS and OS). The sAAIPI predicts outcome for patients with relapsed or primary refractory DLBCL in both intent-to-treat and chemosensitive populations. This powerful prognostic instrument should be used to evaluate new treatment approaches and to compare results of different regimens.
二线化疗后进行高剂量疗法（HDT）并联合自体干细胞移植（ASCT），治愈复发性或难治性弥漫性大B细胞淋巴瘤（DLBCL）患者的比例不到一半。能够预测预后的模型至关重要。在1993年1月至2000年8月进行的3项连续临床试验中，我们用异环磷酰胺、卡铂和依托泊苷（ICE）化疗治疗了150例复发性或原发性难治性DLBCL患者，对化疗敏感的患者随后进行HDT/ASCT。我们将二线治疗开始时的年龄调整国际预后指数（sAAIPI）评估为无进展生存期（PFS）和总生存期（OS）的预测指标。中位随访4年时，意向性治疗的PFS和OS分别为28%和34%，仅化疗敏感患者的PFS和OS分别为39%和45%。sAAIPI确定了三个具有不同PFS和OS的风险组：低风险（0个因素），70%和74%；中风险（1个因素），39%和49%；高风险（2个或3个因素），16%和18%（PFS和OS均P<.001）。sAAIPI还可预测ICE化疗敏感疾病患者的PFS和OS：低风险，69%和83%；中风险，46%和55%；高风险，25%和26%（PFS和OS均P<.001）。sAAIPI可预测意向性治疗和化疗敏感人群中复发性或原发性难治性DLBCL患者的预后。这种强大的预后工具应用于评估新的治疗方法并比较不同方案的结果。
