Watanabe Natsuko, Narimatsu Hiroto, Noh Jaeduk Yoshimura, Kunii Yo, Mukasa Koji, Matsumoto Masako, Suzuki Miho, Sekiya Kenichi, Ohye Hidemi, Yoshihara Ai, Iwaku Kenji, Kobayashi Sakiko, Kameyama Kaori, Kobayashi Kazuhiko, Nishikawa Yoshitaka, Kami Masahiro, Sugino Kiminori, Ito Koichi
1 Ito Hospital , Tokyo, Japan .
Thyroid. 2014 Jun;24(6):994-9. doi: 10.1089/thy.2013.0523. Epub 2014 May 15.
Primary thyroid lymphoma (PTL) develops mostly in middle-aged and older females. However, the optimal treatment for elderly patients with diffuse large B-cell lymphoma (DLBCL), which accounts for most PTL cases, is unclear. Rituximab is a promising drug that, in combination with traditional combination therapy, has demonstrated an increased antitumor effect without a substantial increase in toxicity. In this study, treatment outcomes of elderly patients with thyroid DLBCL who underwent rituximab-including combination therapy were analyzed.
Between January 2005 and December 2011, 43 patients 60 years of age or older (median 71 years, range 60-80 years) were diagnosed as having stage IE (n=12) or stage IIE (n=31) DLBCL, and three courses of R-CHOP therapy (rituximab 375 mg/m2, cyclophosphamide 750 mg/m2, adriamycin 40 mg/m2, vincristine 1.4 mg/m2, and prednisolone 100 mg/body) and involved field irradiation were planned. Treatment outcomes of these patients were retrospectively reviewed.
Two patients terminated the treatment because of interstitial pneumonia during R-CHOP therapy. Only one patient showed treatment resistance and the regimen was changed; 42 patients (98%) responded to the treatment. Five-year overall survival and event-free survival were 87% (95% confidence interval [95% CI], 64-96%) and 74% (95% CI, 50-89%), respectively.
The results of the present study indicate that rituximab-including combination therapy was effective for elderly patients with thyroid DLBCL. A multicenter, long-term observational study is needed to confirm this, and additional refinement of the treatment protocol is required to optimize the antitumor effect.
原发性甲状腺淋巴瘤（PTL）主要发生于中老年女性。然而，弥漫性大B细胞淋巴瘤（DLBCL）占大多数PTL病例，老年DLBCL患者的最佳治疗方案尚不清楚。利妥昔单抗是一种有前景的药物，与传统联合疗法联合使用时，已显示出抗肿瘤效果增强且毒性无显著增加。在本研究中，分析了接受含利妥昔单抗联合治疗的老年甲状腺DLBCL患者的治疗结果。
2005年1月至2011年12月期间，43例60岁及以上（中位年龄71岁，范围60 - 80岁）的患者被诊断为IE期（n = 12）或IIE期（n = 31）DLBCL，并计划进行三个疗程的R-CHOP治疗（利妥昔单抗375mg/m²、环磷酰胺750mg/m²、阿霉素40mg/m²、长春新碱1.4mg/m²、泼尼松龙100mg/体）及受累野照射。对这些患者的治疗结果进行回顾性分析。
2例患者在R-CHOP治疗期间因间质性肺炎终止治疗。仅1例患者显示治疗抵抗并更改了治疗方案；42例患者（98%）对治疗有反应。5年总生存率和无事件生存率分别为87%（95%置信区间[95%CI]，64 - 96%）和74%（95%CI，50 - 89%）。
本研究结果表明，含利妥昔单抗的联合治疗对老年甲状腺DLBCL患者有效。需要进行多中心、长期观察性研究来证实这一点，并且需要进一步完善治疗方案以优化抗肿瘤效果。
