Elhassadi E, Flavin R, Browne P, Conneally E, Hayden P, Quinn F, Higgins E, Vandenberghe E
Haematology Department, St James Hospital, Dublin, Ireland.
Academic Department of Haematology, Trinity College Dublin, Dublin, Ireland.
Ir J Med Sci. 2017 Aug;186(3):589-595. doi: 10.1007/s11845-017-1594-z. Epub 2017 Mar 21.
Retrospective study to evaluate the outcome of patients with transformed follicular lymphoma (tFL) treated with rituximab-containing chemotherapy and consolidation.
Patients diagnosed with tFL from 2003 to 2013 treated with consolidation therapy with last follow-up in December 2015 were identified from the institutional lymphoma database and included in this study. Data collected included age, gender, stage, interval to tFL diagnosis, R-IPI score, histological diagnosis and therapy. The treatment algorithm used was stratified for age, performance status (PS) and sibling donor availability using R-chemotherapy induction followed by consolidation with allogeneic stem cell transplant (SCT), autologous SCT, Zevalin or rituximab maintenance (RM). Patients with B-cell lymphoma with features intermediate between diffuse large B-cell lymphoma and Burkitt's lymphoma (BCL-U), with FISH-proven t(14;18) and t(8;14) and their variants were excluded.
Four hundred patients were diagnosed with FL of whom 26 (7%) developed histologically proven tFL. The group was predominantly male (73%) with a median age at transformation of 53 (range 27-72) years and 85% presented with stage III/IV disease. Thirteen (50%) patients presented with de novo tFL and the remainder had previously diagnosed FL, with a median time to transformation of 5.7 (range 1-15) years. The median follow-up time from tFL diagnosis to December 2015 is 8 (range 4-14) years. All patients received immuno-chemotherapy achieving an overall response rate (ORR) of 100%. Fourteen (54%), patients were transplant eligible and based on donor availability, six had an auto-SCT only, five had an allo-SCT only and three had a matched unrelated allo-SCT for a post-auto-SCT relapse. The 12 patients (46%) who were not transplant eligible were consolidated with rituximab maintenance (RM) in nine (35%) and Zevalin in three (11%) cases. The overall survival (OS) and progression-free survival (PFS) for the series at 5 years were, 92 and 73%, respectively.
This consecutively treated series of 26 patients with tFL have had a better outcome than expected which may be due to the use of rituximab-chemotherapy and a consolidation strategy based on age, PS and availability of a sibling donor.
进行回顾性研究，以评估接受含利妥昔单抗化疗及巩固治疗的转化型滤泡性淋巴瘤（tFL）患者的预后。
从机构淋巴瘤数据库中确定2003年至2013年诊断为tFL并接受巩固治疗且于2015年12月进行末次随访的患者，并纳入本研究。收集的数据包括年龄、性别、分期、至tFL诊断的间隔时间、R-IPI评分、组织学诊断及治疗情况。所采用的治疗方案根据年龄、体能状态（PS）及同胞供者可用性进行分层，采用R-化疗诱导，随后进行异基因干细胞移植（SCT）、自体SCT、泽瓦林或利妥昔单抗维持治疗（RM）巩固。排除具有弥漫性大B细胞淋巴瘤和伯基特淋巴瘤（BCL-U）之间特征的B细胞淋巴瘤患者，以及FISH证实存在t(14;18)和t(8;14)及其变异的患者。
400例患者被诊断为滤泡性淋巴瘤，其中26例（7%）发生组织学证实的tFL。该组以男性为主（73%），转化时的中位年龄为53岁（范围27 - 72岁），85%为Ⅲ/Ⅳ期疾病。13例（50%）患者为初发tFL，其余患者既往诊断为滤泡性淋巴瘤，转化的中位时间为5.7年（范围1 - 15年）。从tFL诊断至2015年12月的中位随访时间为8年（范围4 - 14年）。所有患者均接受免疫化疗，总缓解率（ORR）为100%。14例（54%）患者符合移植条件，根据供者可用性，6例仅接受自体SCT，5例仅接受异基因SCT，3例因自体SCT后复发接受了匹配无关供者的异基因SCT。12例（46%）不符合移植条件的患者中，9例（35%）采用利妥昔单抗维持治疗（RM）巩固，3例（11%）采用泽瓦林巩固。该系列患者5年总生存率（OS）和无进展生存率（PFS）分别为92%和73%。
这一连续治疗的26例tFL患者系列取得了比预期更好的预后，这可能归因于使用了利妥昔单抗化疗以及基于年龄、PS和同胞供者可用性的巩固策略。
