一项前瞻性随机研究，比较中枢淋巴放疗与密集交替三联化疗在治疗I-III期滤泡性淋巴瘤中的分子反应率。

A prospective randomized study to compare the molecular response rates between central lymphatic irradiation and intensive alternating triple chemotherapy in the treatment of stage I-III follicular lymphoma.

作者信息

Ha Chul S, Cabanillas Fernando, Lee Ming S, Tucker Susan L, McLaughlin Peter, Rodriguez Maria A, Younes Anas, Romaguera Jorge E, Mesina Ofelia M, Cox James D

机构信息

Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.

出版信息

Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):188-93. doi: 10.1016/j.ijrobp.2005.01.027.

DOI:10.1016/j.ijrobp.2005.01.027

PMID:16111588

Abstract

PURPOSE

This study was undertaken to compare the molecular response (MR) rates of 2 regimens, central lymphatic irradiation (CLI) and alternating triple therapy (ATT), in the treatment of Stage I-III follicular lymphoma. MR was defined as disappearance of t(14;18) (q32;q21) amplified by polymerase chain reaction (PCR).

PATIENTS AND METHODS

Sixty-five patients with Stage I to III follicular lymphoma were randomized. CLI consisted of the mantle, abdomen, and pelvic radiation fields. ATT alternated among CHOD-Bleo, ESHAP, and NOPP for 12 courses. Bone marrow (BM) and peripheral blood (PB) samples were obtained before treatment for PCR analysis. PCR-positive patients were followed by PCR analysis. The random-effects logistic model was fitted to the data from the posttreatment PCRs. The factors included in the model were treatment arm, type of PCR (BM vs. PB), and time to PCR sample procurement from the date of registration.

RESULTS

At a median follow-up of 71 months, the 5-year relapse-free survival (RFS) rates were 45% and 54% for CLI and ATT, respectively (p = 0.42). The probability of attaining an MR increased with time after registration (p = 0.007), was lower for BM compared with PB (p = 0.012), and was higher for ATT than for CLI (p = 0.020).

CONCLUSION

ATT regimen achieved a higher MR than CLI, although both arms had similar 5-year RFS.

摘要

目的

本研究旨在比较两种治疗方案，即中枢淋巴系统照射（CLI）和交替三联疗法（ATT），在治疗Ⅰ-Ⅲ期滤泡性淋巴瘤中的分子反应（MR）率。MR定义为通过聚合酶链反应（PCR）扩增的t(14;18)（q32;q21）消失。

患者与方法

65例Ⅰ至Ⅲ期滤泡性淋巴瘤患者被随机分组。CLI包括斗篷野、腹部野和盆腔野照射。ATT在CHOD-Bleo、ESHAP和NOPP之间交替进行，共12个疗程。在治疗前采集骨髓（BM）和外周血（PB）样本进行PCR分析。PCR阳性的患者随后进行PCR分析。对治疗后PCR的数据拟合随机效应逻辑模型。模型中纳入的因素包括治疗组、PCR类型（BM与PB）以及从登记日期到采集PCR样本的时间。