Lee Hyewon, Kim Yu Ri, Kim Soo-Jeong, Park Yong, Eom Hyeon-Seok, Oh Sung Yong, Kim Hyo Jung, Kang Hye Jin, Lee Won-Sik, Moon Joon Ho, Won Young-Woong, Kim Tae-Sung, Kim Jin Seok
Center for Hematologic Malignancy, National Cancer Center, Goyang, South Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea.
Ann Hematol. 2017 Nov;96(11):1873-1881. doi: 10.1007/s00277-017-3107-6. Epub 2017 Aug 22.
After introducing a rituximab-containing chemoimmunotherapy (R-CHOP) for diffuse large B cell lymphoma (DLBCL), a partial response (PR) which is regarded as treatment failure is still observed. To investigate the prognostic factors for the DLBCL patients with a PR to R-CHOP, we retrospectively evaluated 758 newly diagnosed DLBCL patients. After R-CHOP, 88 (11.6%) achieved a PR. Three-year progression-free and overall survival rates measured from the date of PR achievement (PFS2 and OS2) were 57.4 and 67.8%, respectively. The secondary International Prognostic Index (IPI2) scores after R-CHOP were low (0-1) in 68.2% and high (2-3) in 31.8% of the patients. The Deauville scores from 18-fluorodeoxyglucose positron emission tomography after R-CHOP showed low (2-3) in 58.0% and high (4) in 42.0% of the patients. High IPI2 and high Deauville scores were associated with worse PFS2 (P < 0.001 and P = 0.009) and OS2 (P = 0.013 and P = 0.067). The high-risk group defined by the IPI2 and Deauville scores, whose scores were both high, showed significantly lower 3-year PFS2 (P < 0.001) and OS2 (P = 0.006) rates compared with those of the other groups. In multivariate analyses, the IPI score of ≥ 3 at diagnosis and bone marrow involvement at diagnosis were independent prognostic factors. In addition, high IPI2-Deauville score after R-CHOP was significantly associated with poor PFS2 (P = 0.009) and demonstrated a trend toward inferior OS2. In conclusion, DLBCL patients who partially responded to R-CHOP are still a heterogeneous group, for which IPI2 and Deauville scores should be evaluated for prediction of prognosis.
在引入含利妥昔单抗的化疗免疫疗法（R-CHOP）治疗弥漫性大B细胞淋巴瘤（DLBCL）后，仍观察到部分缓解（PR）被视为治疗失败的情况。为了研究对R-CHOP治疗有部分缓解的DLBCL患者的预后因素，我们回顾性评估了758例新诊断的DLBCL患者。接受R-CHOP治疗后，88例（11.6%）达到部分缓解。从达到部分缓解之日起测量的三年无进展生存率和总生存率（PFS2和OS2）分别为57.4%和67.8%。R-CHOP治疗后的继发性国际预后指数（IPI2）评分，68.2%的患者为低（0-1）分，31.8%的患者为高（2-3）分。R-CHOP治疗后18-氟脱氧葡萄糖正电子发射断层扫描的Deauville评分，58.0%的患者为低（2-3）分，42.0%的患者为高（4）分。高IPI2和高Deauville评分与较差的PFS2（P < 0.001和P = 0.009）和OS2（P = 0.013和P = 0.067）相关。由IPI2和Deauville评分定义的高危组，其评分均高，与其他组相比，三年PFS2（P < 0.001）和OS2（P = 0.006）率显著更低。在多因素分析中，诊断时IPI评分≥3和诊断时骨髓受累是独立的预后因素。此外，R-CHOP治疗后高IPI2-Deauville评分与较差的PFS2显著相关（P = 0.009），并且显示出OS2较差的趋势。总之，对R-CHOP治疗有部分缓解的DLBCL患者仍然是一个异质性群体，对于该群体应评估IPI2和Deauville评分以预测预后。
