Van Den Neste E, Schmitz N, Mounier N, Gill D, Linch D, Trneny M, Bouadballah R, Radford J, Bargetzi M, Ribrag V, Dührsen U, Ma D, Briere J, Thieblemont C, Bachy E, Moskowitz C H, Glass B, Gisselbrecht C
Cliniques Universitaires UCL Saint-Luc, Brussels, Belgium.
AsklepiosKlinik St Georg, AbteilungHämatologie und Stammzelltransplantation, Hamburg, Germany.
Bone Marrow Transplant. 2017 Feb;52(2):216-221. doi: 10.1038/bmt.2016.213. Epub 2016 Sep 19.
In the CORAL study, 255 chemosensitive relapses with diffuse large B-cell lymphoma (DLBCL) were consolidated with autologous stem cell transplantation (ASCT), and 75 of them relapsed thereafter. The median time between ASCT and progression was 7.1 months. The median age was 56.1 years; tertiary International Prognosis Index (tIPI) observed at relapse was 0-2 in 71.6% of the patients and >2 in 28.4%. The overall response rate to third-line chemotherapy was 44%. The median overall survival (OS) was 10.0 months (median follow-up: 32.8 months). Thirteen patients received an allogeneic SCT, and three a second ASCT. The median OS was shorter among patients who relapsed <6 months (5.7 months) compared with those relapsing ⩾12 months after ASCT (12.6 months, P=0.0221). The median OS in patients achieving CR, PR or no response after the third-line regimen was 37.7 (P<0.0001), 10.0 (P=0.03) and 6.3 months, respectively. The median OS varied according to tIPI: 0-2: 12.6 months and >2: 5.3 months (P=0.0007). In multivariate analysis, tIPI >2, achievement of response and remission lasting <6 months predicted the OS. This report identifies the prognostic factors for DLBCL relapsing after ASCT and thus helps to select patients for experimental therapy.
在CORAL研究中,255例弥漫性大B细胞淋巴瘤(DLBCL)化疗敏感复发患者接受了自体干细胞移植(ASCT)巩固治疗,其中75例随后复发。ASCT与病情进展之间的中位时间为7.1个月。中位年龄为56.1岁;复发时观察到的国际预后指数(IPI)为0 - 2分的患者占71.6%,>2分的患者占28.4%。三线化疗的总缓解率为44%。中位总生存期(OS)为10.0个月(中位随访时间:32.8个月)。13例患者接受了异基因造血干细胞移植,3例接受了第二次自体干细胞移植。与ASCT后复发时间≥12个月的患者(12.6个月,P = 0.0221)相比,复发时间<6个月的患者中位OS较短(5.7个月)。三线治疗方案后达到完全缓解(CR)、部分缓解(PR)或无反应的患者中位OS分别为37.7个月(P<0.0001)、10.0个月(P = 0.03)和6.3个月。中位OS根据IPI有所不同:0 - 2分:12.6个月,>2分:5.3个月(P = 0.0007)。多变量分析显示,IPI>2、达到缓解以及缓解持续时间<6个月可预测总生存期。本报告确定了ASCT后复发的DLBCL的预后因素,从而有助于选择患者进行实验性治疗。
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