Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, 34th and Spruce Street, Philadelphia, PA 19104, USA.
Bone Marrow Transplant. 2012 Aug;47(8):1082-6. doi: 10.1038/bmt.2011.218. Epub 2011 Nov 14.
We retrospectively analyzed 44 patients undergoing first-line treatment for mantle cell lymphoma with R-HyperCVAD, with or without rituximab (R) maintenance or auto-SCT. The primary study end point was PFS; secondary end point was overall survival.Median follow up for all patients was 3.3 years. Median age was 54 years, and 95% (n=42) were stage III or IV at diagnosis. In all, 17 patients underwent consolidative auto-SCT and 12 patients received R maintenance. The overall response rate was 95%, with 91% achieving complete response (CR). Median PFS for all patients was 3.5 years. Median PFS was 2.3 years for patients treated with R-HyperCVAD alone vs 3.9 years (P=0.02) with R-HyperCVAD+ R maintenance and 4.5 years (P=0.01) with R-HyperCVAD+ auto-SCT. For patients who did not achieve CR at interim staging, PFS for R-HyperCVAD alone was 1.4 years vs not reached for R-HyperCVAD+ consolidation (either R maintenance or auto-SCT) (P=0.02). PFS for patients with CR at interim staging was 3.3 years vs not reached (P=0.04) after consolidation. Our data suggest potential improvement in PFS when R-HyperCVAD is consolidated with either R maintenance or auto-SCT. This benefit appears particularly significant in those patients who do not achieve CR at interim restaging.
我们回顾性分析了 44 例接受 R-HyperCVAD 一线治疗套细胞淋巴瘤的患者，其中包括或不包括利妥昔单抗（R）维持或自体外周血造血干细胞移植（auto-SCT）。主要研究终点为无进展生存期（PFS）；次要终点为总生存期（OS）。所有患者的中位随访时间为 3.3 年。中位年龄为 54 岁，95%（n=42）患者在诊断时处于 III 期或 IV 期。共有 17 例患者接受巩固性自体外周血造血干细胞移植，12 例患者接受 R 维持治疗。总缓解率为 95%，其中 91%达到完全缓解（CR）。所有患者的中位 PFS 为 3.5 年。接受 R-HyperCVAD 单药治疗的患者中位 PFS 为 2.3 年，而接受 R-HyperCVAD+R 维持治疗的患者中位 PFS 为 3.9 年（P=0.02），接受 R-HyperCVAD+自体外周血造血干细胞移植的患者中位 PFS 为 4.5 年（P=0.01）。对于在中期分期时未达到 CR 的患者，R-HyperCVAD 单药治疗的 PFS 为 1.4 年，而 R-HyperCVAD+巩固治疗（R 维持或自体外周血造血干细胞移植）未达到（P=0.02）。中期分期达到 CR 的患者的 PFS 为 3.3 年，而巩固治疗后未达到（P=0.04）。我们的数据表明，R-HyperCVAD 与 R 维持或自体外周血造血干细胞移植联合巩固治疗可潜在改善 PFS。这一益处在那些在中期重新分期时未达到 CR 的患者中尤为显著。
