Belada David, Prochazka Vit, Janikova Andrea, Campr Vit, Blahovcova Petra, Pytlik Robert, Sykorova Alice, Klener Pavel, Benesova Katerina, Pirnos Jan, Duras Juraj, Mocikova Heidi, Trneny Marek
4th Department of Internal Medicine - Haematology, Charles University, Hospital and Faculty of Medicine, Hradec Králové, Czech Republic.
Department of Hematology, University Hospital Olomouc, Olomouc, Czech Republic.
Leuk Res. 2018 Oct;73:29-38. doi: 10.1016/j.leukres.2018.08.019. Epub 2018 Aug 31.
The rituximab maintenance (RM) therapy for follicular lymphoma is effective and clinically well tolerated, however there is limited data regarding this from the elderly segment of the population. This analysis was performed to evaluate the efficacy of RM in elderly patients 65 years of age and older and to assess the influence of the induction therapy with immunochemotherapy (R-CHEMO) on the treatment outcome in a real world setting. A total of 232 consecutive patients treated with first-line R-CHEMO and RM (RM1 group; n = 158) or observation (RM0 group; n = 74) were analyzed. The effect of which induction therapy (R-CHOP vs. R-CVP) and the response of the patients to the first-line therapy were also evaluated. The addition of RM improved the treatment results in elderly patients. The 5- year overall survival rate in patients receiving R-CHEMO + RM1 compared to patients receiving R-CHEMO + RM0, was 83.7% (95% CI 76.1-89%) and 64.3% (95% CI 51.8-74.3%), respectively, p = 0.0012. The induction therapy with R-CHOP was found to be more effective than R-CVP but it is necessary to point out higher age of patients in the R-CVP arm. The 5- year overall survival rate in patients using R-CHOP ± RM and R-CVP ± RM was 84.9% (95% CI 77.5-90%), and 65.0% (95% CI 50.1-76.4%), respectively, p = 0.0008. The patients who achieved CR + uCR after having received first-line therapy had better outcomes compared to patients in PR. The 5- year overall survival rate in uCR + CR patients treated with R-CHEMO + RM1 and PR patients treated with R-CHEMO + RM1 was 90.6% and 68.3%, respectively, p = 0.0019. Rituximab maintenance treatment in patients 65 years and older yielded improved survival rates in a real world clinical setting. The R-CHOP regimen seems to be a more effective induction agent than R-CVP but the outcome of less intensively treated patients with R-CVP + RM is also acceptable. The achievement of uCR + CR after first-line therapy is associated with a better outcome.
利妥昔单抗维持（RM）疗法用于滤泡性淋巴瘤有效且临床耐受性良好，但老年人群体中关于此疗法的数据有限。本分析旨在评估RM在65岁及以上老年患者中的疗效，并在真实世界环境中评估免疫化疗诱导治疗（R-CHEMO）对治疗结果的影响。共分析了232例接受一线R-CHEMO和RM治疗（RM1组；n = 158）或观察（RM0组；n = 74）的连续患者。还评估了诱导治疗（R-CHOP与R-CVP）的效果以及患者对一线治疗的反应。添加RM改善了老年患者的治疗结果。接受R-CHEMO + RM1的患者与接受R-CHEMO + RM0的患者相比，5年总生存率分别为83.7%（95%CI 76.1 - 89%）和64.3%（95%CI 51.8 - 74.3%），p = 0.0012。发现R-CHOP诱导治疗比R-CVP更有效，但有必要指出R-CVP组患者年龄更大。使用R-CHOP±RM和R-CVP±RM的患者5年总生存率分别为84.9%（95%CI 77.5 - 90%）和65.0%（95%CI 50.1 - 76.4%），p = 0.0008。接受一线治疗后达到CR + uCR的患者与PR患者相比预后更好。接受R-CHEMO + RM1治疗的uCR + CR患者和PR患者的5年总生存率分别为90.6%和68.3%，p = 0.0019。在真实世界临床环境中，65岁及以上患者的利妥昔单抗维持治疗提高了生存率。R-CHOP方案似乎是比R-CVP更有效的诱导药物，但R-CVP + RM治疗强度较低患者的结果也是可以接受的。一线治疗后达到uCR + CR与更好的预后相关。
