Melén Christopher M, Enblad Gunilla, Sonnevi Kristina, Junlén Henna Riikka, Smedby Karin E, Jerkeman Mats, Wahlin Björn Engelbrekt
Division of Haematology, Department of Medicine, Huddinge, Sweden.
Karolinska Institutet, and Haematology Centre, Karolinska University Hospital, Stockholm, Sweden.
Br J Haematol. 2016 Nov;175(4):614-622. doi: 10.1111/bjh.14399. Epub 2016 Oct 28.
Young patients with diffuse large B-cell lymphoma (DLBCL) are variably treated with rituximab combined with cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP), CHOP-etoposide (R-CHOEP), and anthracycline-based regimens with the addition of high-dose cytarabine/methotrexate (R-HDA/M). Using the nationwide, population-based Swedish Lymphoma Registry, we evaluated outcome, by treatment and Healthcare Region, in all 751 DLBCL patients aged ≤60 years without central nervous involvement, diagnosed in Sweden between 2007 and 2012. Overall survival was estimated using multivariate Cox analysis. In patients with age-adjusted international prognostic index (aaIPI) ≥ 2, the 5-year overall survival (OS) was 70%, 76% and 85% after R-CHOP, R-CHOEP and R-HDA/M, respectively (P = 0·002); the corresponding estimates were 40%, 55%, and 92% in aaIPI = 3 (P = 0·014). There were large therapeutic differences between Sweden's six Healthcare Regions for aaIPI ≥ 2: three were "Moderate" (more R-CHOP) and three "Intensive" (more R-CHOEP and R-HDA/M). Patients with aaIPI ≥ 2 who were treated in the Intensive Regions, showed better OS (P < 0·00005), particularly those with aaIPI = 3 (5-year OS, 62% vs. 30%; P < 0·00005). There were no regional differences in therapy or survival in patients with aaIPI < 2. We conclude that in younger high-risk patients, survival appears superior after more intensive therapy than R-CHOP.
弥漫性大B细胞淋巴瘤（DLBCL）的年轻患者接受利妥昔单抗联合环磷酰胺-阿霉素-长春新碱-泼尼松（R-CHOP）、CHOP-依托泊苷（R-CHOEP）以及添加高剂量阿糖胞苷/甲氨蝶呤的蒽环类药物方案（R-HDA/M）治疗的情况各不相同。我们利用全国性、基于人群的瑞典淋巴瘤登记处的数据，评估了2007年至2012年期间在瑞典诊断的所有751例年龄≤60岁且无中枢神经系统受累的DLBCL患者按治疗方式和医疗保健区域划分的预后情况。采用多变量Cox分析估计总生存期。在年龄调整国际预后指数（aaIPI）≥2的患者中，接受R-CHOP、R-CHOEP和R-HDA/M治疗后的5年总生存率（OS）分别为70%、76%和85%（P = 0·002）；在aaIPI = 3的患者中，相应的估计值分别为40%、55%和92%（P = 0·014）。对于aaIPI≥2的患者，瑞典的六个医疗保健区域之间存在较大的治疗差异：三个区域为“中等强度”（更多采用R-CHOP），三个区域为“强化强度”（更多采用R-CHOEP和R-HDA/M）。在强化强度区域接受治疗的aaIPI≥2的患者显示出更好的总生存期（P < 0·00005），尤其是那些aaIPI = 3的患者（5年总生存期，62%对30%；P < 0·00005）。aaIPI < 2的患者在治疗或生存方面不存在区域差异。我们得出结论，在年轻的高危患者中，强化治疗后的生存率似乎优于R-CHOP。
