初治失败的弥漫性大B细胞淋巴瘤：超高危特征及实验性疗法的基准研究
Diffuse large B-cell lymphoma with primary treatment failure: Ultra-high risk features and benchmarking for experimental therapies.
作者信息
Costa Luciano J, Maddocks Kami, Epperla Narendranath, Reddy Nishitha M, Karmali Reem, Umyarova Elvira, Bachanova Veronika, Costa Cristiana, Glenn Martha J, Chavez Julio C, Calzada Oscar, Lansigan Frederick, Nasheed Hossain, Barta Stefan K, Zhou Zheng, Jaglal Michael, Chhabra Saurabh, Hernandez-Ilizaliturri Francisco, Xavier Ana C, Mehta Amitkumar, Peker Deniz, Forero-Torres Andreas, Al-Mansour Zeina, Evens Andrew M, Cohen Jonathon B, Flowers Christopher R, Fenske Timothy S, Hamadani Mehdi
机构信息
Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Division of Hematology, Ohio state University, Columbus, Ohio, USA.
出版信息
Am J Hematol. 2017 Feb;92(2):161-170. doi: 10.1002/ajh.24615.
The outcomes of patients with DLBCL and primary treatment failure (PTF) in the rituximab era are unclear. We analyzed 331 patients with PTF, defined as primary progression while on upfront chemoimmunotherapy (PP), residual disease at the end of upfront therapy (RD) or relapse < 6 months from end of therapy (early relapse; ER). Median age was 58 years and response to salvage was 41.7%. Two-year OS was 18.5% in PP, 30.6% in RD and 45.5% in ER. The presence of PP, intermediate-high/high NCCN-IPI at time of PTF or MYC translocation predicted 2-year OS of 13.6% constituting ultra-high risk (UHR) features. Among the 132 patients who underwent autologous hematopoietic cell transplantation, 2-year OS was 74.3%, 59.6% and 10.7% for patients with 0,1 and 2-3 UHR features respectively. Patients with PTF and UHR features should be prioritized for clinical trials with newer agents and innovative cellular therapy.
在利妥昔单抗时代，弥漫性大B细胞淋巴瘤（DLBCL）患者及初次治疗失败（PTF）的预后尚不清楚。我们分析了331例PTF患者，其定义为在初始化疗免疫治疗期间出现原发进展（PP）、初始治疗结束时存在残留病灶（RD）或治疗结束后<6个月复发（早期复发；ER）。中位年龄为58岁，挽救治疗的缓解率为41.7%。PP患者的两年总生存率（OS）为18.5%，RD患者为30.6%，ER患者为45.5%。PP的存在、PTF时中高/高NCCN国际预后指数（IPI）或MYC易位预示两年OS为13.6%，构成超高风险（UHR）特征。在132例接受自体造血细胞移植的患者中，分别有0、1和2 - 3个UHR特征的患者两年OS分别为74.3%、59.6%和10.7%。具有PTF和UHR特征的患者应优先参与使用新型药物和创新细胞疗法的临床试验。
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