正电子发射断层扫描时代接受自体干细胞移植的弥漫性大 B 细胞淋巴瘤和惰性淋巴瘤转化患者的预后因素。

Prognostic factors for patients with diffuse large B cell lymphoma and transformed indolent lymphoma undergoing autologous stem cell transplantation in the positron emission tomography era.

机构信息

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.

出版信息

Br J Haematol. 2013 Mar;160(5):608-17. doi: 10.1111/bjh.12176. Epub 2012 Dec 29.

Abstract

In the positron emission tomography (PET) era, traditional prognostic factors may not apply for patients with relapsed/refractory (R/R) diffuse large B cell lymphoma (DLBCL) undergoing autologous stem cell transplantation (ASCT). Moreover, little is known about prognostic factors in patients transplanted for transformed indolent lymphoma (TIL). We conducted a retrospective study of 143 patients with R/R DLBCL and TIL who were transplanted in the last decade and had a post-salvage PET scan. We examined prognostic factors in both groups, and constructed a prognostic score for DLBCL patients. For patients with DLBCL, post-salvage PET response was an important prognostic factor. Advanced age and symptomatic relapse were also significantly associated with outcome. A simple score could stratify patients into three risk groups with 4-year post-ASCT overall survival of 84%, 59%, and 10%, and 4-year progression-free survival of 67%, 41% and 0% (P<0.0001 for both). However, none of those factors (including PET response to salvage) appeared relevant for patients with TIL, despite their comparable overall outcome. Our prognostic score for DLBCL patients undergoing ASCT may be useful for prognostication, for stratification in clinical trials, and to motivate the design of new strategies for patients in the high-risk group, who may not derive benefit from standard ASCT.

摘要

在正电子发射断层扫描(PET)时代,对于接受自体干细胞移植(ASCT)的复发/难治性(R/R)弥漫性大 B 细胞淋巴瘤(DLBCL)患者,传统的预后因素可能不适用。此外,对于接受转化惰性淋巴瘤(TIL)移植的患者,预后因素知之甚少。我们对过去十年中接受 ASCT 治疗且有挽救后 PET 扫描的 143 例 R/R DLBCL 和 TIL 患者进行了回顾性研究。我们检查了两组患者的预后因素,并为 DLBCL 患者构建了预后评分。对于 DLBCL 患者,挽救后 PET 反应是一个重要的预后因素。年龄较大和症状性复发也与结局显著相关。一个简单的评分可以将患者分为三个风险组,接受 ASCT 后 4 年的总生存率分别为 84%、59%和 10%,无进展生存率分别为 67%、41%和 0%(均<0.0001)。然而,对于 TIL 患者,尽管他们的总体结局相当,但这些因素(包括挽救后 PET 反应)似乎都没有相关性。我们为接受 ASCT 的 DLBCL 患者构建的预后评分可能有助于预后判断、临床试验分层以及为高危组患者设计新策略,因为这些患者可能无法从标准 ASCT 中获益。

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