Derenzini Enrico, Musuraca Gerardo, Fanti Stefano, Stefoni Vittorio, Tani Monica, Alinari Lapo, Venturini Filippo, Gandolfi Letizia, Baccarani Michele, Zinzani Pier Luigi
Institute of Hematology and Medical Oncology L. & A. Seràgnoli, University of Bologna, Bologna, Italy.
Cancer. 2008 Nov 1;113(9):2496-503. doi: 10.1002/cncr.23861.
Limited data exist about the role of second-line chemotherapy response assessed by positron emission tomography (PET) as a prognostic factor in patients with aggressive non-Hodgkin Lymphoma (NHL) who undergo autologous stem cell transplantation (ASCT). The objective of this analysis was to investigate the main determinants of prognosis in patients with aggressive B-cell NHL who undergo ASCT, focusing on the impact of pretransplantation PET, secondary age-adjusted International Prognostic Index (sAA-IPI) score, histology, and previous response to first-line chemotherapy.
Seventy-five patients with diffuse, large B-cell lymphoma or grade 3 follicular lymphoma who were treated at the author' institution with second-line chemotherapy (combined ifosfamide, etoposide, and epirubicin [IEV]) followed by ASCT between September 2002 and September 2006 were included. All patients were evaluated by PET after 1 to 3 courses of IEV chemotherapy before ASCT, and all patients received a conditioning regimen of combined carmustine, etoposide, cytosine arabinoside, and melphalan. The prognostic impact of pretransplantation PET, sAA-IPI score, histology, and previous response to first-line chemotherapy was evaluated by univariate and multivariate analyses.
Seventy-two of 75 patients underwent ASCT. In a univariate analysis for progression-free survival (PFS) and overall survival (OS), a significant association was observed with pretransplantation PET (PFS, P< .00001; OS, P< .01) and previous first-line response (PFS, P= .02; OS, P= .04). In the multivariate framework, pretransplantation PET was identified as the only independent prognostic factor (PFS, P< .001; OS, P= .01).
The current data indicated that pretransplantation PET is the main prognostic predictor in patients with aggressive B-cell NHL who are scheduled for ASCT.
关于通过正电子发射断层扫描（PET）评估的二线化疗反应作为接受自体干细胞移植（ASCT）的侵袭性非霍奇金淋巴瘤（NHL）患者预后因素的作用，现有数据有限。本分析的目的是研究接受ASCT的侵袭性B细胞NHL患者预后的主要决定因素，重点关注移植前PET、年龄校正后的国际预后指数（sAA-IPI）评分、组织学以及对一线化疗的既往反应的影响。
纳入2002年9月至2006年9月期间在作者所在机构接受二线化疗（异环磷酰胺、依托泊苷和表柔比星联合[IEV]）后进行ASCT的75例弥漫性大B细胞淋巴瘤或3级滤泡性淋巴瘤患者。所有患者在ASCT前接受1至3个疗程的IEV化疗后进行PET评估，所有患者均接受卡莫司汀、依托泊苷、阿糖胞苷和美法仑联合预处理方案。通过单因素和多因素分析评估移植前PET、sAA-IPI评分、组织学以及对一线化疗的既往反应的预后影响。
75例患者中有72例接受了ASCT。在无进展生存期（PFS）和总生存期（OS）的单因素分析中，观察到移植前PET（PFS，P<0.00001；OS，P<0.01）和既往一线反应（PFS，P = 0.02；OS，P = 0.04）之间存在显著关联。在多因素分析中，移植前PET被确定为唯一的独立预后因素（PFS，P<0.001；OS，P = 0.01）。
目前的数据表明，移植前PET是计划接受ASCT的侵袭性B细胞NHL患者的主要预后预测指标。
