Kondo Eisei
Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
J Clin Exp Hematop. 2016;56(2):100-108. doi: 10.3960/jslrt.56.100.
High-dose chemotherapy supported by autologous stem cell support/transplantation (HDT/ASCT) has been a standard of care over the last two decades in patients with relapsed or refractory(R/R) diffuse large B-cell lymphoma (DLBCL), which is sensitive to salvage chemotherapy. HDT/ASCT for high-risk DLBCL in upfront setting remains controversial, so it is not recommended for clinical practice. Various promising salvage chemotherapy regimens have been reported in phase 2 studies; however, two large randomized phase 3 studies showed similar efficacy of R-ICE vs. R-DHAP and R-GDP vs. R-DHAP. Since the registry data shows feasibility and efficacy of HDT/ASCT in elderly R/R DLBCL patients, older age (> 65 years) itself is not a contraindication for HDT/ASCT. Rituximab maintenance failed to demonstrate a significant benefit compared with observation only after HDT/ASCT. While sensitive R/R DLBCL might be cured by HDT/ASCT even in third-line therapy, the prognosis of insensitive R/R DLBCL is extremely poor. Further study to establish treatment strategies for high-risk patients defined by prognostic factors or biomarkers, and insensitive patients is warranted.
在过去二十年中，对于复发或难治性（R/R）弥漫性大B细胞淋巴瘤（DLBCL）患者，自体干细胞支持/移植（HDT/ASCT）辅助的大剂量化疗一直是一种标准治疗方法，DLBCL对挽救性化疗敏感。HDT/ASCT用于一线治疗高危DLBCL仍存在争议，因此不推荐用于临床实践。在2期研究中报告了各种有前景的挽救性化疗方案；然而，两项大型随机3期研究显示R-ICE与R-DHAP以及R-GDP与R-DHAP的疗效相似。由于登记数据显示HDT/ASCT在老年R/R DLBCL患者中具有可行性和疗效，年龄较大（>65岁）本身并非HDT/ASCT的禁忌证。与HDT/ASCT后仅观察相比，利妥昔单抗维持治疗未能显示出显著益处。虽然敏感的R/R DLBCL即使在三线治疗中也可能通过HDT/ASCT治愈，但不敏感的R/R DLBCL预后极差。有必要进一步研究以确立针对由预后因素或生物标志物定义的高危患者以及不敏感患者的治疗策略。
