免疫表型和中间-高国际预后指数评分是弥漫性大 B 细胞淋巴瘤患者治疗的预后因素。

Immunophenotype and intermediate-high international prognostic index score are prognostic factors for therapy in diffuse large B-cell lymphoma patients.

机构信息

Institute of Hematology and Medical Oncology L. e A. Seràgnoli, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.

出版信息

Cancer. 2010 Dec 15;116(24):5667-75. doi: 10.1002/cncr.25307. Epub 2010 Aug 24.

DOI:10.1002/cncr.25307

PMID:20737566

Abstract

BACKGROUND

The development of gene expression profiling and tissue microarray techniques have provided more information about the heterogeneity of diffuse large B-cell lymphoma (DLBCL), enabling categorization of DLBCL patients into 3 prognostic groups according to cell origin (but independently from the International Prognostic Index [IPI] score): germinal center (GCB), activated B-cell (ABC), and not classified (NC) diffuse large B-cell lymphoma. This study investigated the role of immunohistochemical discrimination between GCB and ABC&NC-DLBCL subtypes in identifying those high-risk patients who may benefit from a more aggressive first-line therapeutic approach.

METHODS

From February 2003 to August 2006, 45 newly diagnosed DLBCL patients, with IPI≥2, were considered eligible for this study: 13 had a GCB, 8 an ABC, and 24 a NC-DLBCL. GCB patients received 6 courses of rituximab, cyclophophosphamide, doxorubicin, vinicristine, and prednisone (R-CHOP) chemotherapy, with a subsequent, autologous stem cell transplantation in case of partial response. All ABC and NC-DLBCL patients received 6 R-CHOP cycles and autologous stem cell transplantation.

RESULTS

Complete response rate for each treatment arm was 84.6% for GCB and 89.7% for ABC&NC-DLBCL (P = .50), with a continuous complete response rate of 81.8% and 84.6%, respectively (P = .59). Projected 4-year overall survival is 100% for GCB and 82% for ABC&NC patients (P = .12). Progression-free survival is 77% and 79% (P = .7), respectively.

CONCLUSIONS

The autologous stem cell transplantation consolidation in the ABC&NC-DLBCL subtypes induced the same rate of complete response (and similar progression-free survival rate) compared with GCB-DLBCL. In ABC&NC-DLBCL patients the authors observed a complete response rate of 89.7% vs. 84.6% in the GCB-DLBCL subset, without any significant difference in progression-free survival rate.

摘要

背景

基因表达谱和组织微阵列技术的发展为弥漫性大 B 细胞淋巴瘤（DLBCL）的异质性提供了更多信息，使 DLBCL 患者能够根据细胞起源（与国际预后指数[IPI]评分无关）分为 3 个预后组：生发中心（GCB）、激活 B 细胞（ABC）和未分类（NC）弥漫性大 B 细胞淋巴瘤。本研究探讨了免疫组织化学区分 GCB 和 ABC&NC-DLBCL 亚型在识别可能受益于更积极一线治疗方法的高危患者中的作用。

方法

从 2003 年 2 月至 2006 年 8 月，45 例新诊断的 IPI≥2 的 DLBCL 患者符合本研究条件：13 例为 GCB 患者，8 例为 ABC 患者，24 例为 NC-DLBCL 患者。GCB 患者接受 6 个疗程的利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）化疗，如果部分缓解，随后进行自体干细胞移植。所有 ABC 和 NC-DLBCL 患者接受 6 个 R-CHOP 周期和自体干细胞移植。

结果

每个治疗组的完全缓解率分别为 GCB 组的 84.6%和 ABC&NC-DLBCL 组的 89.7%（P=0.50），完全缓解持续率分别为 81.8%和 84.6%（P=0.59）。预计 4 年总生存率分别为 GCB 组的 100%和 ABC&NC 患者的 82%（P=0.12）。无进展生存率分别为 77%和 79%（P=0.7）。