Shah Nirav N, Szabo Aniko, Huntington Scott F, Epperla Narendranath, Reddy Nishitha, Ganguly Siddhartha, Vose Julie, Obiozor Cynthia, Faruqi Fahad, Kovach Alexandra E, Costa Luciano J, Xavier Ana C, Okal Ryan, Kanate Abraham S, Ghosh Nilanjan, Kharfan-Dabaja Mohamed A, Strelec Lauren, Hamadani Mehdi, Fenske Timothy S, Calzada Oscar, Cohen Jonathon B, Chavez Julio, Svoboda Jakub
Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA.
Br J Haematol. 2018 Feb;180(4):534-544. doi: 10.1111/bjh.15051. Epub 2017 Dec 19.
Primary mediastinal (thymic) large B-cell lymphoma (PMBCL) is an uncommon subtype of non-Hodgkin lymphoma (NHL) that presents with a mediastinal mass and has unique clinicopathological features. Historically, patients with PMBCL were treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy ± involved field radiation. Since a phase II trial, published in April 2013, demonstrated excellent results using dose-adjusted (DA) R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin), this treatment has gained popularity. We performed a retrospective, multicentre analysis of patients aged ≥18 years with PMBCL since January 2011. Patients were stratified by frontline regimen, R-CHOP versus DA-R-EPOCH. 132 patients were identified from 11 contributing centres (56 R-CHOP and 76 DA-R-EPOCH). The primary outcome was overall survival. Secondary outcomes included progression-free survival, complete response (CR) rate, and rates of treatment-related complications. Demographic characteristics were similar in both groups. DA-R-EPOCH use increased after April 2013 (79% vs. 45%, P < 0·001), and there was less radiation use after DA-R-EPOCH (13% vs. 59%, P < 0·001). While CR rates were higher with DA-R-EPOCH (84% vs. 70%, P = 0·046), these patients were more likely to experience treatment-related toxicities. At 2 years, 89% of R-CHOP patients and 91% of DA-R-EPOCH patients were alive. To our knowledge, this represents the largest series comparing outcomes of R-CHOP to DA-R-EPOCH for PMBCL.
原发性纵隔（胸腺）大B细胞淋巴瘤（PMBCL）是非霍奇金淋巴瘤（NHL）的一种罕见亚型，表现为纵隔肿块，具有独特的临床病理特征。历史上，PMBCL患者接受R-CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱、泼尼松）化疗±受累野放疗。自2013年4月发表的一项II期试验证明使用剂量调整（DA）的R-EPOCH（利妥昔单抗、依托泊苷、泼尼松、长春新碱、环磷酰胺、多柔比星）疗效优异以来，这种治疗方法越来越受欢迎。我们对自2011年1月起年龄≥18岁的PMBCL患者进行了一项回顾性多中心分析。患者根据一线治疗方案分层，即R-CHOP与DA-R-EPOCH。从11个参与中心确定了132例患者（56例R-CHOP和76例DA-R-EPOCH）。主要结局是总生存期。次要结局包括无进展生存期、完全缓解（CR）率和治疗相关并发症发生率。两组的人口统计学特征相似。2013年4月后DA-R-EPOCH的使用增加（79%对45%，P<0.001），DA-R-EPOCH后放疗的使用减少（13%对59%，P<0.001）。虽然DA-R-EPOCH的CR率更高（84%对70%，P=0.046），但这些患者更有可能经历治疗相关毒性。2年时，89%的R-CHOP患者和91%的DA-R-EPOCH患者存活。据我们所知，这是比较R-CHOP与DA-R-EPOCH治疗PMBCL结局的最大系列研究。
