Zhang M C, Qian Y, Hao J, Liu Z Y, Zhao W L, Wang L
State Key Laboratory of Medical Genomics; Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai 200025, China.
Zhonghua Xue Ye Xue Za Zhi. 2017 Jun 14;38(6):511-516. doi: 10.3760/cma.j.issn.0253-2727.2017.06.009.
To evaluate the efficacy and prognostic factors of second-line regimens for patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). A retrospective analysis was performed in 98 patients with relapsed/refractory DLBCL who were treated with salvage regimens in Rui Jin Hospital from July 2004 to June 2016. Overall response rate (ORR) was evaluated after all treatment finished. Overall survival (OS) was analyzed by Kaplan-Meier method and multivariate by Cox proportional hazards models. There were 60 males and 38 females with a median age of 55.5 (15-77) years. 48 (49.0%) patients responded to chemotherapy, and 32 (32.7%) patients achieved complete remission (CR). Factors affecting ORR were progression disease or refractory/relapse status less than 12 months after diagnosis ((2)=5.878, =0.015) , IPI intermediate-high/high risk ((2)=5.930, =0.015) and NCCN-IPI intermediate-high/high risk ((2)=4.961, =0.026). No significance difference was observed in ORR between germinal-center B-cell type (GCB) and non-GCB ((2)=0.660, =0.417). One-year and 2-year OS rates were 51.0% and 31.5%, with median OS at 13.17 months, respectively. Multivariate analysis indicated NCCN-IPI intermediate-high/high risk[=2.176 (95% 1.338-3.538) , =0.002] and response to chemotherapy [=0.273 (95% 0.165-0.452) , <0.001] were independent prognostic factors for survival. NCCN-IPI is a valid predictor of outcome for patients with relapse/refractory DLBCL. Response to chemotherapy is an independent prognostic factor for better survival.
评估复发/难治性弥漫性大B细胞淋巴瘤（DLBCL）患者二线治疗方案的疗效及预后因素。对2004年7月至2016年6月在瑞金医院接受挽救性治疗方案的98例复发/难治性DLBCL患者进行回顾性分析。所有治疗结束后评估总缓解率（ORR）。采用Kaplan-Meier法分析总生存期（OS），并通过Cox比例风险模型进行多因素分析。患者中男性60例，女性38例，中位年龄55.5（15 - 77）岁。48例（49.0%）患者对化疗有反应，32例（32.7%）患者达到完全缓解（CR）。影响ORR的因素有诊断后12个月内疾病进展或难治/复发状态（χ² = 5.878，P = 0.015）、国际预后指数（IPI）中高/高危（χ² = 5.930，P = 0.015）以及美国国立综合癌症网络（NCCN）-IPI中高/高危（χ² = 4.961，P = 0.026）。生发中心B细胞型（GCB）和非GCB型患者的ORR差异无统计学意义（χ² = 0.660，P = 0.417）。1年和2年OS率分别为51.0%和31.5%，中位OS为13.17个月。多因素分析表明，NCCN-IPI中高/高危[HR = 2.176（95%CI 1.338 - 3.538），P = 0.002]和对化疗的反应[HR = 0.273（95%CI 0.165 - 0.452），P < 0.001]是生存的独立预后因素。NCCN-IPI是复发/难治性DLBCL患者预后的有效预测指标。对化疗的反应是生存更好的独立预后因素。
