一线 R-CHOP 治疗后部分缓解或疾病稳定的弥漫性大 B 细胞淋巴瘤患者:绝对淋巴细胞计数的预后价值和自体干细胞移植的影响。
Patients with diffuse large B cell lymphoma in partial response or stable disease after first-line R-CHOP: the prognostic value of the absolute lymphocyte count and impact of autologous stem cell transplantation.
机构信息
Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan 11217, Republic of China.
出版信息
Ann Hematol. 2012 Dec;91(12):1907-15. doi: 10.1007/s00277-012-1536-9. Epub 2012 Aug 11.
Certain portions of patients with diffuse large B cell lymphoma (DLBCL) do not achieve a complete remission after first-line rituximab combining chemotherapy. This retrospective study aimed to characterize the outcome of patients with DLBCL that achieved partial remission or had stable disease after first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone). The effects of subsequent treatments and factors associated with event-free survival (EFS) after second-line treatments were analyzed. A total of 103 patients were enrolled and 81 (76.8 %) patients received intensive chemotherapy, whereas the others (23.2 %) received either palliative chemotherapy or supportive care post first-line treatment. Patients receiving intensive chemotherapy had significantly higher EFS (median 7.9 months) than the others; 28 (34.6 %) patients in this group received autologous stem cell transplantation (ASCT), which may have further improved the EFS. An International Prognostic Index (IPI) >2 and absolute lymphocyte count (ALC) at diagnosis <1,000/UL were significant prognostic factors associated with worse EFS. The survival advantage of ASCT remained significant after adjustment for these factors. The results suggest intensive chemotherapy plus ASCT may provide modest disease control in patients with DLBCL who achieve PR or SD to first-line R-CHOP, particularly in those with a higher IPI score and/or low ALC at diagnosis.
某些弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者在一线利妥昔单抗联合化疗后无法达到完全缓解。本回顾性研究旨在描述一线 R-CHOP(利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松)治疗后达到部分缓解或疾病稳定的 DLBCL 患者的结局。分析了二线治疗后的后续治疗效果以及与无事件生存(EFS)相关的因素。共纳入 103 例患者,其中 81 例(76.8%)患者接受强化化疗,而其余 23.2%的患者在一线治疗后接受姑息化疗或支持治疗。接受强化化疗的患者 EFS 显著更高(中位 7.9 个月);该组中有 28 例(34.6%)患者接受了自体干细胞移植(ASCT),这可能进一步改善了 EFS。国际预后指数(IPI)>2 和诊断时绝对淋巴细胞计数(ALC)<1,000/μL 是与 EFS 较差相关的显著预后因素。在调整这些因素后,ASCT 的生存优势仍然显著。这些结果表明,对于一线 R-CHOP 治疗后达到 PR 或 SD 的 DLBCL 患者,强化化疗加 ASCT 可能提供适度的疾病控制,特别是对于 IPI 评分较高和/或诊断时 ALC 较低的患者。