在一个大型、连续的老年弥漫性大 B 细胞淋巴瘤患者队列中，采用根治性治疗，意向和相对剂量强度的 R-CHOP 对累积复发率的影响：按年龄比较患者无差异。
Impact of intended and relative dose intensity of R-CHOP in a large, consecutive cohort of elderly diffuse large B-cell lymphoma patients treated with curative intent: no difference in cumulative incidence of relapse comparing patients by age.
机构信息
Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
出版信息
J Intern Med. 2019 Jun;285(6):681-692. doi: 10.1111/joim.12889. Epub 2019 Apr 11.
BACKGROUND
The increasing incidence of diffuse large B-cell lymphoma (DLBCL) in ageing populations places a significant burden on healthcare systems. Co-morbidity, frailty, and reduced organ and physiological reserve contribute to treatment-related complications. The optimal dose intensity of R-CHOP to optimize outcome across different ages with variable frailty and comorbidity burden is unclear.
OBJECTIVES AND METHODS
We examined the influence of intended (IDI) and relative (RDI) dose intensity of the combination of cyclophosphamide and doxorubicin, age and comorbidity on outcomes for DLBCL patients ≥70 years in a representative, consecutive cohort across eight UK centres (2009-2018). We determined predictors of survival using multivariable Cox regression, and predictors of recurrence before death using competing risks regression.
RESULTS
Porgression-free survival (PFS) and overall survival (OS) were significantly inferior in patients ≥80 vs. 70-79 years (P < 0.001). In contrast, 2-year cumulative relapse incidence, when accounting for non-relapse mortality as a competing risk, was no different between 70-79 vs. ≥80 years (P = 0.27) or comorbidity status (CIRS-G: 0-6 vs. >6) (P = 0.27). In 70-79 years, patients with an IDI ≥80% had a significantly improved PFS and OS (P < 0.001) compared to IDI < 80%. Conversely, in patients ≥80 years, there was no difference in PFS (P = 0.88) or OS (P = 0.75) according to IDI <80% vs. ≥80%. On multivariable analysis, when comparing by age, there was a significantly higher cumulative relapse rate for patients aged 70-79 years with an IDI <80% (vs. >80%) (P = 0.04) but not for patients ≥80 years comparing IDI (P = 0.32).
CONCLUSION
'R-mini-CHOP' provides adequate lymphoma-specific disease control and represents a reasonable treatment option in elderly patients ≥80 years aiming for cure.
背景
随着老年人口中弥漫性大 B 细胞淋巴瘤（DLBCL）发病率的增加，对医疗系统造成了重大负担。合并症、虚弱和器官及生理储备减少导致与治疗相关的并发症。不同年龄、虚弱程度和合并症负担的 R-CHOP 最佳剂量强度以优化结果尚不清楚。
目的和方法
我们在 8 个英国中心（2009-2018 年）的代表性连续队列中，研究了环磷酰胺和多柔比星的意向（IDI）和相对剂量强度（RDI）、年龄和合并症对 70 岁以上 DLBCL 患者结局的影响。我们使用多变量 Cox 回归确定生存的预测因素，并使用竞争风险回归确定死亡前复发的预测因素。
结果
与 70-79 岁患者相比，≥80 岁患者的无进展生存（PFS）和总生存（OS）明显更差（P<0.001）。相比之下，在考虑非复发死亡率作为竞争风险时，70-79 岁与≥80 岁之间（P=0.27）或合并症状态（CIRS-G：0-6 与>6）（P=0.27）之间的 2 年累积复发发生率并无差异。在 70-79 岁患者中，IDI≥80%的患者 PFS 和 OS 显著改善（P<0.001），与 IDI<80%的患者相比。相反，在≥80 岁的患者中，IDI<80%与 IDI≥80%的患者之间 PFS 无差异（P=0.88）或 OS 无差异（P=0.75）。在多变量分析中，按年龄比较时，IDI<80%的 70-79 岁患者累积复发率显著高于 IDI>80%的患者（P=0.04），但≥80 岁患者比较 IDI 时则无差异（P=0.32）。
结论
“R-mini-CHOP”可提供充分的淋巴瘤特异性疾病控制，并且对于旨在治愈的≥80 岁老年患者来说是一种合理的治疗选择。
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