弥漫大 B 细胞淋巴瘤成人患者接受 RCHOP 治疗后的风险分层，维持性利妥昔单抗治疗或观察：多中心经验。
How to determine post-RCHOP therapy for risk-tailored adult patients with diffuse large B-cell lymphoma, addition of maintenance rituximab or observation: multicenter experience.
机构信息
Department of Hematology, The Affiliated Hospital of Inner Mongolia Medical College, 1 TongDao Avenue North, 010059, Hohhot, People's Republic of China.
出版信息
J Cancer Res Clin Oncol. 2012 Jan;138(1):125-32. doi: 10.1007/s00432-011-1074-1. Epub 2011 Nov 6.
BACKGROUND
In international prognostic index (IPI) risk-tailored adult patients with diffuse large B-cell lymphoma (DLBCL), it is still unclear whether the addition of maintenance rituximab (MR) improves progression-free (PFS) and overall survival (OS), after RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) therapy.
METHODS
In our study, 207 patients (age: 21-59 years) received six 14-day cycles of RCHOP and gained overall response. After RCHOP, 98 patients were enrolled in the observation (OBS) arm. 109 patients continued to receive MR therapy.
RESULTS
In IPI risk <2 profile, PFS at 5 years reached 72.9% (MR arm) versus 56% (OBS arm) (P = 0.033). In IPI risk ≥2 profile, PFS estimation at 5 years was 44.9% (MR arm) versus 33.5% (OBS arm) (P = 0.006). It is noteworthy that patients with IPI ≥2 who received MR achieved PFS similar to that for patients in the OBS arm with the IPI <2, 44.9% versus 56% (P = 0.97). In patients with an IPI <2, OS at 5 years was 83.2% (MR arm) versus 81.2% (OBS arm) (P = 0.708). In patients with an IPI ≥2, 5-year OS estimation was 44.6% (MR arm) versus 40.5% (OBS arm) (P = 0.067). Subgroup analysis of patients with an IPI ≥3 risk profile shows a survival benefit for patients receiving MR. OS at 5 years was 62% (MR arm) versus 49% (OBS arm), (P = 0.033).
CONCLUSIONS
In conclusion, maintenance rituximab after RCHOP improves progression-free survival. In addition, overall survival is improved for patients with an IPI ≥3 risk profile receiving MR.
背景
在国际预后指数（IPI）风险分层的成人弥漫性大 B 细胞淋巴瘤（DLBCL）患者中，尚不清楚在接受 R-CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松）治疗后，加用维持性利妥昔单抗（MR）是否能改善无进展生存（PFS）和总生存（OS）。
方法
在我们的研究中，207 名（年龄：21-59 岁）患者接受了六个 14 天周期的 R-CHOP 治疗，并获得了总体缓解。在 R-CHOP 之后，98 名患者被纳入观察组（OBS）。109 名患者继续接受 MR 治疗。
结果
在 IPI 风险<2 谱中，MR 组 5 年 PFS 率为 72.9%，而 OBS 组为 56%（P=0.033）。在 IPI 风险≥2 谱中，MR 组 5 年 PFS 估计值为 44.9%，OBS 组为 33.5%（P=0.006）。值得注意的是，接受 MR 治疗的 IPI≥2 患者的 PFS 与 IPI<2 且接受 OBS 治疗的患者相似，分别为 44.9%和 56%（P=0.97）。在 IPI<2 的患者中，MR 组 5 年 OS 率为 83.2%，OBS 组为 81.2%（P=0.708）。在 IPI≥2 的患者中，MR 组 5 年 OS 估计值为 44.6%，OBS 组为 40.5%（P=0.067）。IPI≥3 风险谱患者的亚组分析显示，接受 MR 治疗的患者有生存获益。5 年 OS 率为 62%（MR 组）和 49%（OBS 组）（P=0.033）。
结论
综上所述，R-CHOP 后维持性利妥昔单抗可改善无进展生存。此外，接受 MR 治疗的 IPI≥3 风险谱患者的总生存得到改善。
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