Armitage J O, Vose J M, Linder J, Weisenburger D, Harrington D, Casey J, Bierman P, Sorensen S, Hutchins M, Moravec D F
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68105-1065.
J Clin Oncol. 1989 Dec;7(12):1783-90. doi: 10.1200/JCO.1989.7.12.1783.
We performed a prospective study of the clinical significance of immunophenotype in 110 patients with aggressive non-Hodgkin's lymphoma (NHL) treated by oncologists in the Nebraska Lymphoma Study Group between October 1982 and May 1986. All patients were immunophenotyped from biopsies performed before therapy was administered. The patients were treated with a uniform protocol of radiotherapy for minimal nonbulky, stage I or II disease (seven patients) or a single, six-drug chemotherapy regimen cyclophosphamide, doxorubicin, procarbazine, bleomycin, vincristine, and prednisone (CAP-BOP) in patients with more extensive disease (103 patients). Ninety-one patients (83%) had B-cell lymphoma and 19 patients (17%) had T-cell lymphoma. The histologic diagnosis of diffuse mixed-cell lymphoma was significantly associated with T-cell immunophenotype (45% v 5%; P less than .001), and the diagnosis of diffuse large-cell lymphoma was significantly associated with B-cell immunophenotype (40% v 5%; P = .006). However, no significant difference in frequency of prognostic variables such as age, stage, systemic symptoms, tumor bulk, serum lactic dehydrogenase, or performance status was found between the B-cell and T-cell groups. Patients with B-cell NHL had a slightly higher complete remission rate (74% v 53%; P = NS), similar durability of complete remission (75% v 70% at 3 years; P = NS), and a slightly but not significantly better overall survival (50% v 41% at 3 years; P = NS). The slight advantage in response rate and survival for B-cell patients was related to a very poor outcome for patients with stage IV T-cell NHL. For patients with stage I to III disease, neither the complete remission rate (B-cell, 82% v T-cell, 91%; P = NS) nor overall survival (3-year survival for B cell, 58% v T cell, 73%; P = NS) were significantly different. However, with stage IV disease B-cell patients fared far better than those with T-cell NHL for both complete remission rate (67% v 0%; P = .002) and overall survival (3-year survival, 44% v 0%; P = .002). Immunophenotyping intermediate- and high-grade NHL allowed identification of a subgroup of patients who had a very poor prognosis with this treatment approach and for whom alternate therapy might be considered.
1982年10月至1986年5月期间，内布拉斯加淋巴瘤研究组的肿瘤学家对110例侵袭性非霍奇金淋巴瘤（NHL）患者免疫表型的临床意义进行了一项前瞻性研究。所有患者在接受治疗前均对活检组织进行了免疫表型分析。对于病灶微小、非肿块性的Ⅰ期或Ⅱ期疾病患者（7例），采用统一的放射治疗方案；对于病情更广泛的患者（103例），采用单一的六药联合化疗方案，即环磷酰胺、阿霉素、丙卡巴肼、博来霉素、长春新碱和泼尼松（CAP - BOP）。91例患者（83%）为B细胞淋巴瘤，19例患者（17%）为T细胞淋巴瘤。弥漫性混合细胞淋巴瘤的组织学诊断与T细胞免疫表型显著相关（45%对5%；P＜0.001），弥漫性大细胞淋巴瘤的诊断与B细胞免疫表型显著相关（40%对5%；P = 0.006）。然而，B细胞组和T细胞组在年龄、分期、全身症状、肿瘤大小、血清乳酸脱氢酶或体能状态等预后变量的频率上没有显著差异。B细胞NHL患者的完全缓解率略高（74%对53%；P = 无显著性差异），完全缓解的持续时间相似（3年时为75%对70%；P = 无显著性差异），总体生存率略高但无显著差异（3年时为50%对41%；P = 无显著性差异）。B细胞患者在缓解率和生存率方面的轻微优势与Ⅳ期T细胞NHL患者的极差预后有关。对于Ⅰ至Ⅲ期疾病患者，完全缓解率（B细胞为82%，T细胞为91%；P = 无显著性差异）和总体生存率（B细胞3年生存率为58%，T细胞为73%；P = 无显著性差异）均无显著差异。然而，对于Ⅳ期疾病，B细胞患者在完全缓解率（67%对0%；P = 0.002）和总体生存率（3年生存率，44%对0%；P = 0.002）方面均远优于T细胞NHL患者。对中高级NHL进行免疫表型分析，可识别出一组采用这种治疗方法预后极差的患者，对于这些患者可考虑采用其他治疗方法。
