苯达莫司汀联合利妥昔单抗对比 R-CHOP 一线治疗 3A 级滤泡性淋巴瘤患者：一项多中心回顾性研究的证据。
Bendamustine plus Rituximab Versus R-CHOP as First-Line Treatment for Patients with Follicular Lymphoma Grade 3A: Evidence from a Multicenter, Retrospective Study.
机构信息
Department of Human Pathology, University of Messina, Messina, Italy
Department of Biological and Environmental Sciences, University of Messina, Messina, Italy.
出版信息
Oncologist. 2018 Apr;23(4):454-460. doi: 10.1634/theoncologist.2017-0037. Epub 2018 Jan 9.
BACKGROUND
Rituximab plus bendamustine (R-B) has been demonstrated to improve outcomes and reduce toxicity compared with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP) in follicular lymphoma (FL). Nevertheless, in clinical practice, many centers still prefer R-CHOP to R-B in patients with FL grade 3A (FL3A). Therefore, we retrospectively assessed patients with FL3A treated with either R-CHOP or R-B in five European cancer centers and compared their outcomes.
MATERIALS AND METHODS
We retrospectively assessed 132 patients affected by FL grade 3A treated with either R-B or R-CHOP in the first line and evaluated outcome and toxicity according to the type of treatment. This study included 101 patients who were a subgroup of a previously published cohort.
RESULTS
R-B was less toxic and achieved a similar percentage of complete remissions compared with R-CHOP (97% vs. 96%, = .3). During follow-up, 10 (16%) patients relapsed after R-B and 29 (41%) after R-CHOP ( = .001), leading to a median progression-free survival (PFS) of 15 versus 11.7 years, respectively ( = .03). Furthermore, R-B overcame the negative prognostic impact of BCL2 expression (15 vs. 4.8 years; = .001). However, median overall survival was similar between both groups (not reached for both; = .8).
CONCLUSION
R-B as a first-line treatment of FL3A is better tolerated than R-CHOP and seems to induce more profound responses, leading to a significantly lower relapse rate and prolonged PFS. Therefore, R-B is a valid treatment option for FL grade 3A.
IMPLICATIONS FOR PRACTICE
Rituximab plus bendamustine (R-B) has shown to be less toxic and more effective than rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP) in follicular lymphoma grade 3A. Although both regimens can induce a complete remission in >95% of patients, relapses occur more frequently after R-CHOP than R-B, leading to a significantly longer progression-free survival in the latter. R-B is also able to overcome the impact of negative prognosticators, such as BCL2 expression. However, because of the indolent course of this disease and efficient salvage treatments, overall survival was similar in both treatment groups. Therefore, R-B is a valid treatment option in this patient setting.
背景
利妥昔单抗联合苯达莫司汀（R-B）与利妥昔单抗、环磷酰胺、多柔比星和泼尼松（R-CHOP）相比，已被证明可改善滤泡淋巴瘤（FL）患者的预后并降低毒性。然而，在临床实践中，许多中心在治疗 FL3A 患者时仍倾向于使用 R-CHOP 而非 R-B。因此，我们在五个欧洲癌症中心回顾性评估了接受 R-CHOP 或 R-B 一线治疗的 FL3A 患者，并比较了他们的结局。
材料与方法
我们回顾性评估了 132 例接受一线 R-B 或 R-CHOP 治疗的 FL3A 患者，并根据治疗类型评估了结局和毒性。本研究包括之前发表的队列中的 101 例患者。
结果
R-B 的毒性低于 R-CHOP，且完全缓解率相似（97% vs. 96%，= 0.3）。在随访期间，R-B 后有 10 例（16%）患者复发，R-CHOP 后有 29 例（41%）患者复发（= 0.001），导致 R-B 的无进展生存期（PFS）中位数为 15 年，而 R-CHOP 为 11.7 年（= 0.03）。此外，R-B 克服了 BCL2 表达的负预后影响（15 年 vs. 4.8 年；= 0.001）。然而，两组的总生存期中位数无差异（均未达到；= 0.8）。
结论
R-B 作为 FL3A 的一线治疗方法，其耐受性优于 R-CHOP，且似乎能诱导更深刻的反应，从而显著降低复发率并延长 PFS。因此，R-B 是 FL 级 3A 的一种有效治疗选择。
实践意义
利妥昔单抗联合苯达莫司汀（R-B）在滤泡性淋巴瘤 3A 级中已显示出比利妥昔单抗、环磷酰胺、多柔比星和泼尼松（R-CHOP）毒性更低且更有效。虽然两种方案都能使超过 95%的患者获得完全缓解，但 R-CHOP 后复发率高于 R-B，导致后者的无进展生存期显著延长。R-B 还能够克服 BCL2 表达等负预后因素的影响。然而，由于该疾病的惰性病程和有效的挽救性治疗，两组患者的总生存期相似。因此，R-B 是该患者群体的一种有效治疗选择。
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