Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, USA.
Oncology (Williston Park). 2012 May;26(5):488-95.
Diffuse large B-cell lymphoma (DLBCL) is the most commonly occurring lymphoid malignancy. While a series of trials support R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone, plus rituximab)-21 as the standard of care for all patients, DLBCL has substantial biological and clinical heterogeneity, leading to marked differences in outcomes for disease subgroups. We examine clinical, biological, and functional imaging techniques for risk-stratifying patients, and we review approaches for dose intensification in the rituximab era that are aimed at improving outcomes for poor-risk patients. Together, the results achieved with these measures indicate no particular benefit for administering R-CHOP-14 vs R-CHOP-21 in older or younger patients with DLBCL, highlight opportunities for future studies of young patients with high-risk DLBCL, and suggest the promise of biologic risk stratification. Such approaches will provide key opportunities for further advances in the treatment of DLBCL, given that chemotherapy intensification appears to provide limited additional benefits over the current standard of care.
弥漫性大 B 细胞淋巴瘤（DLBCL）是最常见的淋巴恶性肿瘤。虽然一系列临床试验支持 R-CHOP（环磷酰胺、多柔比星、长春新碱和泼尼松，加用利妥昔单抗）-21 作为所有患者的标准治疗方案，但 DLBCL 具有显著的生物学和临床异质性，导致疾病亚组的预后存在明显差异。我们研究了用于患者分层风险的临床、生物学和功能影像学技术，并回顾了在利妥昔单抗时代强化剂量的方法，旨在改善高危患者的预后。这些措施的结果表明，对于老年或年轻的 DLBCL 患者，给予 R-CHOP-14 与 R-CHOP-21 并无特别获益，为高危 DLBCL 年轻患者的未来研究提供了机会，并提示了生物学风险分层的前景。鉴于化疗强化似乎仅为当前标准治疗提供有限的额外获益，这些方法将为 DLBCL 的治疗提供进一步进展的关键机会。
