Fcγ 受体 IIIA 多态性与利妥昔单抗治疗中国弥漫性大 B 细胞淋巴瘤的疗效。

Fcgamma receptor IIIA polymorphisms and efficacy of rituximab therapy on Chinese diffuse large B-cell lymphoma.

机构信息

Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China.

出版信息

Chin Med J (Engl). 2010 Jan 20;123(2):198-202.

PMID:20137370

Abstract

BACKGROUND

Rituximab is used extensively in combination with chemotherapy to cure non-Hodgkin's lymphoma (NHL), and not only accelerates short-term improvement, but also prolongs patient survival and decreases receptor relapse. The aim of this study was to evaluate the impact of Fcgamma IIIA (FcgammaRIIIA) gene polymorphisms on the response to rituximab therapy for newly diagnosed B-cell lymphomas.

METHODS

Patients with newly diagnosed histologically-proven CD20-positive B-cell lymphoma were eligible for the study. All of the patients received rituximab combined with chemotherapy (CHOP). The FcgammaRIIIA type was analyzed by PCR. The initial efficacy was assessed after 6 cycles and the long-term survival was determined.

RESULTS

Thirty-four patients were recruited between October 2005 and April 2006. The FcgammaRIIIA distribution was as follows: 11 patients were VV, 5 were FF, and 18 were VF. After a median of 6 cycles (range 4-8) of rituximab combined chemotherapy, the overall response rate was 79% (82% in the VV group, 83% in the VF group, and 60% in the FF group; P=0.04). After a median follow-up time of 37 months (range 34-41), there were 12 relapses among 27 responders (44%); 5 of 9 patients (5/9) in the VV group, 5 of 15 patients (33%) in the VF group, and 2 of 3 patients (2/3) in the FF group (P=0.21). The 1-year overall survival in the VV, FF, and VF groups was 80%, 60%, and 80%, respectively, and the 3-year overall survival was 58%, 40%, and 69%, respectively (P=0.08). After analysis by COX regression, only the international prognosis index and response to initial treatment were significantly related to overall survival.

CONCLUSIONS

The distribution of FcgammaRIIIA polymorphisms in this B-cell lymphoma population shows that VF is most frequently expressed, followed by VV and FF. Patients with the FcgammaRIIIA VV and VF types are more sensitive to the initial treatment of rituximab combined with chemotherapy and have superior long-term survival compared with those with FF. Nevertheless, FcgammaRIIIA polymorphisms do not predict prognosis independently.

摘要

背景

利妥昔单抗广泛应用于联合化疗治疗非霍奇金淋巴瘤（NHL），不仅能加速短期改善，还能延长患者的生存时间并降低受体复发率。本研究旨在评估 Fcγ 受体 IIIA（FcγRIIIA）基因多态性对新诊断 B 细胞淋巴瘤患者利妥昔单抗治疗反应的影响。

方法

本研究纳入了经组织学证实的 CD20 阳性 B 细胞淋巴瘤的新诊断患者。所有患者均接受利妥昔单抗联合化疗（CHOP）治疗。通过 PCR 分析 FcγRIIIA 类型。在 6 个周期后评估初始疗效，确定长期生存情况。

结果

2005 年 10 月至 2006 年 4 月期间共招募了 34 例患者。FcγRIIIA 分布如下：11 例为 VV，5 例为 FF，18 例为 VF。在接受中位数为 6 个周期（范围 4-8）的利妥昔单抗联合化疗后，总体缓解率为 79%（VV 组为 82%，VF 组为 83%，FF 组为 60%；P=0.04）。中位随访时间为 37 个月（范围 34-41），27 例缓解者中有 12 例（44%）复发；9 例 VV 组中 5 例（5/9），15 例 VF 组中 5 例（33%），3 例 FF 组中 2 例（2/3）（P=0.21）。VV、FF 和 VF 组的 1 年总生存率分别为 80%、60%和 80%，3 年总生存率分别为 58%、40%和 69%（P=0.08）。通过 COX 回归分析，仅国际预后指数和初始治疗反应与总生存率显著相关。