Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA.
Br J Haematol. 2019 May;185(4):670-678. doi: 10.1111/bjh.15814. Epub 2019 Feb 28.
In a prospective phase II trial, pentostatin combined with cyclophosphamide and rituximab (PCR) induced strong responses and was well-tolerated in previously untreated patients with advanced-stage, indolent non-Hodgkin lymphoma (iNHL). After a median patient follow-up of more than 108 months, we performed an intent-to-treat analysis of our 83 participants. Progression-free survival (PFS) rates at 108 months for follicular lymphoma (FL), marginal zone lymphoma (MZL) and small lymphocytic lymphoma (SLL) were 71%, 67% and 15%, respectively, and were affected by clinicopathological characteristics. Ten-year PFS rates for those with beta-2-microglobulin levels <2·2 and ≥2·2 mg/l prior to treatment were 71% and 21%, respectively. Patients without bone marrow involvement had 10-year PFS rates of 72% vs. 29% for those with involvement. At time of analysis, the median overall survival (OS) had not been reached. The OS rate was 64% at 10 years and differed significantly based on histology: 94% for FL, 66% for MZL and 39% for SLL. Long-term toxicities included 18 (21·7%) patients with second malignancies and 2 (2·4%) who developed myelodysplastic syndrome after receiving additional lines of chemotherapy. Our 10-year follow-up analysis confirms that PCR is an effective, robust and tolerable treatment regimen for patients with iNHL.
在一项前瞻性的 II 期临床试验中，喷司他丁联合环磷酰胺和利妥昔单抗（PCR）在未经治疗的晚期惰性非霍奇金淋巴瘤（iNHL）患者中诱导了强烈的反应，并具有良好的耐受性。在中位患者随访超过 108 个月后，我们对 83 名参与者进行了意向治疗分析。108 个月时滤泡性淋巴瘤（FL）、边缘区淋巴瘤（MZL）和小淋巴细胞淋巴瘤（SLL）的无进展生存（PFS）率分别为 71%、67%和 15%，并受临床病理特征的影响。治疗前β-2-微球蛋白水平<2.2 和≥2.2mg/l 的患者，10 年 PFS 率分别为 71%和 21%。无骨髓受累的患者 10 年 PFS 率为 72%，而受累患者为 29%。在分析时，中位总生存（OS）尚未达到。10 年 OS 率为 64%，且根据组织学显著不同：FL 为 94%，MZL 为 66%，SLL 为 39%。长期毒性包括 18 名（21.7%）患者发生第二恶性肿瘤和 2 名（2.4%）患者在接受额外化疗后发生骨髓增生异常综合征。我们的 10 年随访分析证实，PCR 是 iNHL 患者有效、强大且耐受良好的治疗方案。
