Mian Michael, Augustin Florian, Kocher Florian, Gunsilius Eberhard, Willenbacher Wolfgang, Zabernigg August, Zangerl Günther, Oexle Horst, Schreieck Stefan, Schnallinger Michael, Fiegl Michael
Department of Hematology & Oncology, Medical University of Innsbruck, Austria.
Anticancer Res. 2014 May;34(5):2559-64.
Diffuse large B-cell lymphoma (DLBCL) is a rather aggressive disease and the natural course of this lymphoma is very dismal. However, first the introduction of anthracycline-containing chemotherapy regimens and then the addition of rituximab were important steps forward. Since no complete real-life analyses have yet been published, we analyzed all patients with DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) in the whole region of Tyrol and compared the results to a historical CHOP(-like)-treated cohort. Two hundred and nineteen consecutive patients underwent R-CHOP and 72% achieved a complete remission (CR); 20% suffered a relapse and 31% died. 5-Year progression-free survival (PFS) and overall survival (OS) were 56% and 69%, respectively. We identified several parameters influencing PFS and OS significantly in univariate analysis, but only stage III/IV and hemoglobin <13 g/dl were independent prognosticators for PFS and age >60 years for OS. In comparison to the CHOP(-like)-treated group, the CR rate was similar, while the percentage of relapse was nearly twice in the historical cohort, namely 44%. This translated into a dramatically improved PFS and OS for the R-CHOP group. In conclusion, in a real-life setting R-CHOP results in high percentages of response and long-term remission. Moreover we showed that in the rituximab era, factors other than the single parameters of the international prognostic index significantly influence PFS and OS. Finally, we confirm the independent impact of rituximab on the outcome of an unselected population with DLBCL.
弥漫性大B细胞淋巴瘤（DLBCL）是一种侵袭性较强的疾病，其自然病程非常严峻。然而，首先含蒽环类化疗方案的引入，随后利妥昔单抗的加入是重要的进展。由于尚未发表完整的真实世界分析，我们分析了蒂罗尔整个地区接受利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）治疗的所有DLBCL患者，并将结果与历史CHOP（类）治疗队列进行比较。219例连续患者接受了R-CHOP治疗，72%达到完全缓解（CR）；20%复发，31%死亡。5年无进展生存期（PFS）和总生存期（OS）分别为56%和69%。我们在单因素分析中确定了几个显著影响PFS和OS的参数，但只有Ⅲ/Ⅳ期和血红蛋白<13 g/dl是PFS的独立预后因素，年龄>60岁是OS的独立预后因素。与CHOP（类）治疗组相比，CR率相似，而历史队列中的复发率几乎是其两倍，即44%。这使得R-CHOP组的PFS和OS显著改善。总之，在真实世界中，R-CHOP导致高比例的缓解和长期缓解。此外，我们表明在利妥昔单抗时代，国际预后指数的单个参数以外的因素显著影响PFS和OS。最后，我们证实了利妥昔单抗对未选择的DLBCL人群结局的独立影响。
