复发或难治性双表达和双打击淋巴瘤在自体干细胞移植后的无进展生存期较差。
Relapsed or Refractory Double-Expressor and Double-Hit Lymphomas Have Inferior Progression-Free Survival After Autologous Stem-Cell Transplantation.
作者信息
Herrera Alex F, Mei Matthew, Low Lawrence, Kim Haesook T, Griffin Gabriel K, Song Joo Y, Merryman Reid W, Bedell Victoria, Pak Christine, Sun Heather, Paris Tanya, Stiller Tracey, Brown Jennifer R, Budde Lihua E, Chan Wing C, Chen Robert, Davids Matthew S, Freedman Arnold S, Fisher David C, Jacobsen Eric D, Jacobson Caron A, LaCasce Ann S, Murata-Collins Joyce, Nademanee Auayporn P, Palmer Joycelynne M, Pihan German A, Pillai Raju, Popplewell Leslie, Siddiqi Tanya, Sohani Aliyah R, Zain Jasmine, Rosen Steven T, Kwak Larry W, Weinstock David M, Forman Stephen J, Weisenburger Dennis D, Kim Young, Rodig Scott J, Krishnan Amrita, Armand Philippe
机构信息
Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA.
出版信息
J Clin Oncol. 2017 Jan;35(1):24-31. doi: 10.1200/JCO.2016.68.2740. Epub 2016 Oct 24.
Purpose Double-hit lymphomas (DHLs) and double-expressor lymphomas (DELs) are subtypes of diffuse large B-cell lymphoma (DLBCL) associated with poor outcomes after standard chemoimmunotherapy. Data are limited regarding outcomes of patients with relapsed or refractory (rel/ref) DEL or DHL who undergo autologous stem-cell transplantation (ASCT). We retrospectively studied the prognostic impact of DEL and DHL status on ASCT outcomes in patients with rel/ref DLBCL. Methods Patients with chemotherapy-sensitive rel/ref DLBCL who underwent ASCT at two institutions and in whom archival tumor material was available were enrolled. Immunohistochemistry for MYC, BCL2, and BCL6 and fluorescence in situ hybridization (FISH) for MYC were performed. In cases with MYC rearrangement or copy gain, FISH for BCL2 and BCL6 was also performed. Results A total of 117 patients were included; 44% had DEL and 10% had DHL. DEL and DHL were associated with inferior progression-free survival (PFS), and DHL was associated with poorer overall survival (OS). The 4-year PFS in patients with DEL compared with those with non-DEL was 48% versus 59% ( P = .049), and the 4-year OS was 56% versus 67% ( P = .10); 4-year PFS in patients with DHL compared with those with non-DHL was 28% versus 57% ( P = .013), and 4-year OS was 25% versus 61% ( P = .002). The few patients with concurrent DEL and DHL had a poor outcome (4-year PFS, 0%). In multivariable models, DEL and DHL were independently associated with inferior PFS, whereas DHL and partial response ( v complete response) at transplant were associated with inferior OS. Conclusion DEL and DHL are both associated with inferior outcomes after ASCT in patients with rel/ref DLBCL. Although ASCT remains a potentially curative approach, these patients, particularly those with DHL, are a high-risk subset who should be targeted for investigational strategies other than standard ASCT.
目的 双打击淋巴瘤（DHL）和双表达淋巴瘤（DEL）是弥漫性大B细胞淋巴瘤（DLBCL）的亚型，与标准化疗免疫治疗后的不良预后相关。关于复发或难治性（rel/ref）DEL或DHL患者接受自体干细胞移植（ASCT）的预后数据有限。我们回顾性研究了DEL和DHL状态对rel/ref DLBCL患者ASCT预后的影响。方法 纳入在两家机构接受ASCT且有存档肿瘤材料的化疗敏感型rel/ref DLBCL患者。进行MYC、BCL2和BCL6的免疫组织化学检测以及MYC的荧光原位杂交（FISH）检测。对于存在MYC重排或拷贝数增加的病例，还进行BCL2和BCL6的FISH检测。结果 共纳入117例患者；44%为DEL，10%为DHL。DEL和DHL与无进展生存期（PFS）较差相关，DHL与总生存期（OS）较差相关。DEL患者与非DEL患者的4年PFS分别为48%和59%（P = 0.049），4年OS分别为56%和67%（P = 0.10）；DHL患者与非DHL患者的4年PFS分别为28%和57%（P = 0.013），4年OS分别为25%和61%（P = 0.002）。少数同时患有DEL和DHL的患者预后较差（4年PFS为0%）。在多变量模型中，DEL和DHL与较差的PFS独立相关，而DHL和移植时的部分缓解（相对于完全缓解）与较差的OS相关。结论 DEL和DHL均与rel/ref DLBCL患者ASCT后的不良预后相关。尽管ASCT仍然是一种潜在的治愈方法，但这些患者，尤其是那些患有DHL的患者，是高危亚组，应针对其开展标准ASCT以外的研究策略。
Zotero 插件