Sauter Craig S, Matasar Matthew J, Meikle Jessica, Schoder Heiko, Ulaner Gary A, Migliacci Jocelyn C, Hilden Patrick, Devlin Sean M, Zelenetz Andrew D, Moskowitz Craig H
Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY;
Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;
Blood. 2015 Apr 16;125(16):2579-81. doi: 10.1182/blood-2014-10-606939. Epub 2015 Mar 10.
High-dose chemotherapy (HDT) plus autologous stem cell transplantation (ASCT) is the standard of care for chemosensitive relapsed and refractory diffuse large B-cell lymphoma (rel/ref DLBCL). Interim restaging with functional imaging by positron emission tomography using (18)F-deoxyglucose (FDG-PET) has not been established after salvage chemotherapy (ST) and before HDT-ASCT by modern criteria. Herein, we evaluated 129 patients with rel/ref DLBCL proceeding to HDT-ASCT, with ST response assessment by FDG-PET according to the contemporary Deauville 5-point scale. At 3 years, patients achieving a Deauville response of 1 to 3 to ST experienced superior progression-free survival (PFS) and overall survival (OS) rates of 77% and 86%, respectively, compared with patients achieving Deauville 4 (49% and 54%, respectively) (P < .001). No other pre-HDT-ASCT risk factors significantly impacted PFS or OS. Despite achieving remission to ST, patients with Deauville 4 should be the focus of risk-adapted investigational therapies.
大剂量化疗（HDT）联合自体干细胞移植（ASCT）是化疗敏感的复发难治性弥漫性大B细胞淋巴瘤（rel/ref DLBCL）的标准治疗方案。按照现代标准，在挽救性化疗（ST）后及HDT-ASCT前，尚未确立通过使用（18）F-脱氧葡萄糖的正电子发射断层扫描进行功能成像的中期再分期。在此，我们评估了129例接受HDT-ASCT的rel/ref DLBCL患者，根据当代的多维尔5分制量表，通过FDG-PET对ST反应进行评估。3年时，可以看到，与多维尔评分为4分的患者（分别为49%和54%）相比，ST达到多维尔反应1至3分的患者的无进展生存期（PFS）和总生存期（OS）分别达到了77%和86%，更具优势（P <.001）。没有其他HDT-ASCT前的危险因素对PFS或OS有显著影响。尽管对ST达到了缓解，但多维尔评分为4分的患者应成为风险适应性研究性治疗的重点。
