Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York.
Cancer. 2013 Dec 1;119(23):4129-36. doi: 10.1002/cncr.28350. Epub 2013 Sep 4.
Drug choice and delivered dose of treatment potentially influence outcome in patients treated for follicular lymphoma (FL). Historically, observational studies have evaluated drug choice. The National LymphoCare Study (NLCS) is a prospective, observational study of patients with FL who were enrolled at academic and community practice sites in the United States between 2004 and 2007. In the current study, the authors report on measures of delivered dose and its impact on outcomes for the most common first-line regimens.
All evaluable patients with FL who were treated with initial rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP); rituximab plus cyclophosphamide, vincristine, and prednisone (R-CVP); or rituximab plus a fludarabine-containing regimen (R-Flu) were included. Associations between baseline factors, choice of treatment, number of cycles received, completion of therapy, and patient outcomes were assessed.
A total of 646 patients received R-CHOP, 297 received R-CVP, and 222 received R-Flu. Characteristics were similar between the 3 groups with the following exceptions. Patients receiving R-CHOP were more often found to have grade 3 FL and patients receiving R-CVP were older and had higher Follicular Lymphoma International Prognostic Index scores. The majority of patients (80%) received ≥ 5 cycles of treatment. Toxicity, but not disease progression, was commonly cited as the reason for the early discontinuation of treatment (51% vs 6%). Time to retreatment was shorter for patients receiving ≤ 4 cycles, regardless of the treatment regimen used. The number of cycles was associated with overall survival, progression-free survival, and lymphoma-related mortality for patients receiving R-CVP.
The majority of patients with FL receiving chemoimmunotherapy in the NLCS completed ≥ 5 cycles of treatment. Strategies to improve dose delivery appear unlikely to impact outcomes, except possibly in patients receiving R-CVP. Although early treatment discontinuation appears to be associated with survival, this analysis does not implicate causality.
药物选择和治疗剂量的给予可能会影响滤泡性淋巴瘤（FL）患者的治疗效果。历史上，观察性研究已经评估了药物选择。国家淋巴瘤护理研究（NLCS）是一项在美国的学术和社区实践地点于 2004 年至 2007 年期间招募的 FL 患者的前瞻性、观察性研究。在当前的研究中，作者报告了最常见的一线治疗方案的给予剂量及其对结果的影响。
所有可评估的接受初始利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）；利妥昔单抗联合环磷酰胺、长春新碱和泼尼松（R-CVP）；或利妥昔单抗联合氟达拉滨方案（R-Flu）治疗的 FL 患者均被纳入研究。评估了基线因素、治疗选择、接受的周期数、治疗完成情况和患者结局之间的关系。
共 646 例患者接受 R-CHOP、297 例患者接受 R-CVP、222 例患者接受 R-Flu。3 组患者的特征相似，除以下几点外。接受 R-CHOP 的患者更常被发现为 3 级 FL，而接受 R-CVP 的患者年龄更大且滤泡性淋巴瘤国际预后指数评分更高。大多数患者（80%）接受了≥5 个周期的治疗。毒性，而不是疾病进展，通常被认为是提前停止治疗的原因（51% vs 6%）。无论使用何种治疗方案，接受≤4 个周期治疗的患者再次治疗的时间更短。接受 R-CVP 治疗的患者的周期数与总生存期、无进展生存期和淋巴瘤相关死亡率相关。
NLCS 中接受化疗免疫治疗的大多数 FL 患者完成了≥5 个周期的治疗。改善剂量给予的策略似乎不太可能影响结局，除非在接受 R-CVP 治疗的患者中可能有影响。尽管早期治疗中断似乎与生存相关，但该分析并不能暗示因果关系。
