利妥昔单抗时代年轻套细胞淋巴瘤患者的生存结局。
Survival Outcomes of Younger Patients With Mantle Cell Lymphoma Treated in the Rituximab Era.
机构信息
1 Fox Chase Cancer Center, Philadelphia, PA.
2 BC Cancer, Vancouver, British Columbia, Canada.
出版信息
J Clin Oncol. 2019 Feb 20;37(6):471-480. doi: 10.1200/JCO.18.00690. Epub 2019 Jan 7.
PURPOSE
Mantle cell lymphoma (MCL) is a B-cell lymphoma characterized by cyclin D1 expression. Autologous hematopoietic cell transplantation (AHCT) consolidation after induction chemotherapy is often used for eligible patients; however, the benefit remains uncertain in the rituximab era. Herein we retrospectively assessed the impact of AHCT consolidation on survival in a large cohort of transplantation-eligible patients age 65 years or younger.
PATIENTS AND METHODS
We retrospectively studied transplantation-eligible adults age 65 years or younger with newly diagnosed MCL treated between 2000 and 2015. The primary objective was to assess for improved progression-free survival (PFS) with AHCT consolidation and secondarily to assess for improved overall survival (OS). Cox multivariable regression analysis and propensity score-weighted (PSW) analysis were performed.
RESULTS
Data were collected from 25 medical centers for 1,254 patients; 1,029 met inclusion criteria. Median follow-up for the cohort was 76 months. Median PFS and OS were 62 and 139 months, respectively. On unadjusted analysis, AHCT was associated with improved PFS (75 v 44 months with v without AHCT, respectively; P < .01) and OS (147 v 115 months with v without AHCT, respectively; P < .05). On multivariable regression analysis, AHCT was associated with improved PFS (hazard ratio [HR], 0.54; 95% CI, 0.44 to 0.66; P < .01) and a trend toward improved OS (HR, 0.77; 95% CI, 0.59 to 1.01; P = .06). After PSW analysis, AHCT remained associated with improved PFS (HR, 0.70; 95% CI, 0.59 to 0.84; P < .05) but not improved OS (HR, 0.87; 95% CI, 0.69 to 1.1; P = .2).
CONCLUSION
In this large cohort of younger, transplantation-eligible patients with MCL, AHCT consolidation after induction was associated with significantly improved PFS but not OS after PSW analysis. Within the limitations of a retrospective analysis, our findings suggest that in younger, fit patients, AHCT consolidation may improve PFS.
目的
套细胞淋巴瘤（MCL）是一种以 cyclin D1 表达为特征的 B 细胞淋巴瘤。对于符合条件的患者，通常在诱导化疗后进行自体造血细胞移植（AHCT）巩固治疗；然而，在利妥昔单抗时代，其获益仍不确定。在此，我们回顾性评估了在一组年龄在 65 岁或以下的、适合移植的大患者队列中，AHCT 巩固治疗对生存的影响。
患者和方法
我们回顾性研究了 2000 年至 2015 年间诊断为 MCL 的年龄在 65 岁或以下、适合移植的成年人。主要目的是评估 AHCT 巩固治疗是否能改善无进展生存期（PFS），次要目的是评估是否能改善总生存期（OS）。我们进行了 Cox 多变量回归分析和倾向评分加权（PSW）分析。
结果
该研究的数据来自 25 个医疗中心的 1254 例患者，其中 1029 例符合纳入标准。队列的中位随访时间为 76 个月。中位 PFS 和 OS 分别为 62 个月和 139 个月。在未调整的分析中，AHCT 与改善的 PFS（75 个月与无 AHCT 组的 44 个月相比；P <.01）和 OS（147 个月与无 AHCT 组的 115 个月相比；P <.05）相关。在多变量回归分析中，AHCT 与改善的 PFS 相关（风险比[HR]，0.54；95%CI，0.44 至 0.66；P <.01），OS 有改善趋势（HR，0.77；95%CI，0.59 至 1.01；P =.06）。在 PSW 分析后，AHCT 仍然与改善的 PFS 相关（HR，0.70；95%CI，0.59 至 0.84；P <.05），但与改善的 OS 无关（HR，0.87；95%CI，0.69 至 1.1；P =.2）。
结论
在这组年龄较小、适合移植的 MCL 患者中，诱导后进行 AHCT 巩固治疗与 PFS 显著改善相关，但 PSW 分析后与 OS 无关。在回顾性分析的局限性内，我们的研究结果表明，在年轻、身体状况良好的患者中，AHCT 巩固治疗可能会改善 PFS。
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