Department of Hematology and.
Institute of Pathology, Aarhus University Hospital, Aarhus, Denmark.
Blood Adv. 2018 Jul 10;2(13):1562-1571. doi: 10.1182/bloodadvances.2018017673.
The introduction of the anti-CD20 antibody rituximab in combination with chemotherapy (R-chemo) has improved the prognosis of patients with follicular lymphoma (FL). During the last decade, the addition of a maintenance treatment with rituximab (MR) after R-chemo has been tested with the hope of further improving the outcome of these patients. Using 2 independent population-based cohorts, we investigated the effect of up-front MR on time related end points as well as the risk of histological transformation (HT). FL patients were included if they: (1) completed first-line induction treatment with R-chemo, (2) were alive after induction treatment and eligible for MR, and (3) had no evidence of HT at this time point. The training cohort consisted of 733 Danish patients of whom 364 were consolidated with MR; 369 were not. Patients receiving MR more often had advanced clinical stage (90% vs 78%), high Follicular Lymphoma International Prognostic Index (FLIPI) score (64% vs 55%), and bone marrow infiltration (49% vs 40%). Those consolidated with MR had an improved 5-year overall survival (OS; 89% vs 81%; = .001) and progression-free survival (PFS; 72% vs 60%; < .001). In the training cohort, MR was associated with a reduction of HT risk ( = .049). Analyses of an independent validation cohort of 190 Finnish patients confirmed the favorable impact of MR on 5-year OS (89% vs 81%; = .046) and PFS (70% vs 57%; = .005) but did not find a reduced risk of HT. The present population-based data suggest that the outcome of patients with FL has improved after consolidation of R-chemo with MR.
抗 CD20 抗体利妥昔单抗联合化疗（R-chemo）的引入改善了滤泡性淋巴瘤（FL）患者的预后。在过去的十年中，人们尝试在 R-chemo 后进行维持治疗（MR），希望进一步改善这些患者的预后。我们使用 2 个独立的基于人群的队列，研究了 upfront MR 对时间相关终点以及组织学转化（HT）风险的影响。FL 患者符合以下条件方可纳入：（1）完成一线 R-chemo 诱导治疗；（2）诱导治疗后存活且有资格接受 MR；（3）此时无 HT 证据。训练队列包括 733 名丹麦患者，其中 364 名接受了 MR 巩固治疗；369 名未接受。接受 MR 治疗的患者更常处于晚期临床阶段（90%比 78%）、高滤泡性淋巴瘤国际预后指数（FLIPI）评分（64%比 55%）和骨髓浸润（49%比 40%）。接受 MR 巩固治疗的患者 5 年总生存率（OS；89%比 81%；.001）和无进展生存率（PFS；72%比 60%； <.001）得到改善。在训练队列中，MR 与 HT 风险降低相关（.049）。对来自芬兰的 190 名患者的独立验证队列的分析证实了 MR 对 5 年 OS（89%比 81%；.046）和 PFS（70%比 57%；.005）的有利影响，但未发现 HT 风险降低。本基于人群的数据表明，在 R-chemo 后进行 MR 巩固治疗后，FL 患者的预后得到改善。
Zotero 插件