在利妥昔单抗应用前时代和利妥昔单抗时代，鼻腔鼻窦弥漫性大 B 细胞淋巴瘤患者的临床特征和转归。
Clinical features and outcome of the patients with sinonasal tract diffuse large B-cell lymphoma in the pre-rituximab and rituximab eras.
机构信息
Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Department of Otorhinolaryngology - Head and Neck Surgery and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
出版信息
Eur J Haematol. 2019 Jun;102(6):457-464. doi: 10.1111/ejh.13225. Epub 2019 Apr 9.
PURPOSE
Sinonasal tract diffuse large B-cell lymphoma (SNT-DLBCL), a rare extranodal lymphoma, is not well characterized. We performed a population-based study to determine cell-of-origin, clinical presentation and impact of rituximab (R) and central nervous system (CNS) directed chemotherapy on survival.
PATIENTS AND METHODS
Patients with SNT-DLBCL were identified from pathology databases. Clinical information was collected and outcomes between different treatment modalities evaluated.
RESULTS
Thirty-two percent of the patients had germinal centre B-cell phenotype. Forty-six patients were treated with curative intent using CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CHOP-like chemotherapy, 21 (46%) before and 25 (54%) in the R-era. Additionally, 24 (52%) received CNS-directed chemotherapy. Addition of R to chemotherapy reduced the risk of progression (RR = 0.368, 95% CI 0.138-0.976, P = 0.045) and death (RR = 0.245, 95% CI 0.068-0.883, P = 0.032), and translated into better survival (5-year PFS, 67% vs 38%, P = 0.037; 5-year OS, 81% vs 48%, P = 0.020). CNS-directed chemotherapy reduced the risk of progression (RR = 0.404, 95% CI 0.159-1.029, P = 0.057) and death (RR = 0.298, 95% CI 0.093-0.950, P = 0.041), and translated into favorable survival (5-year PFS, 67% vs 32%, P = 0.050; 5-year OS 82% vs 43%, P = 0.030).
CONCLUSION
Patients with SNT-DLBCL benefit from rituximab and CNS-directed chemotherapy.
目的
鼻窦黏膜相关弥漫性大 B 细胞淋巴瘤（SNT-DLBCL）是一种罕见的结外淋巴瘤，其特征尚未完全明确。我们进行了一项基于人群的研究，旨在确定生发中心 B 细胞表型、临床表现以及利妥昔单抗（R）和中枢神经系统（CNS）导向化疗对生存的影响。
方法
从病理数据库中确定 SNT-DLBCL 患者。收集临床信息并评估不同治疗方式的结果。
结果
32%的患者具有生发中心 B 细胞表型。46 例患者采用 CHOP（环磷酰胺、多柔比星、长春新碱、泼尼松）或 R-CHOP 样化疗进行根治性治疗，21 例（46%）在 R 时代前，25 例（54%）在 R 时代后。此外，24 例（52%）接受了 CNS 导向化疗。化疗中加入 R 可降低进展风险（RR=0.368，95%CI 0.138-0.976，P=0.045）和死亡风险（RR=0.245，95%CI 0.068-0.883，P=0.032），并转化为更好的生存（5 年 PFS，67%比 38%，P=0.037；5 年 OS，81%比 48%，P=0.020）。CNS 导向化疗降低了进展风险（RR=0.404，95%CI 0.159-1.029，P=0.057）和死亡风险（RR=0.298，95%CI 0.093-0.950，P=0.041），并转化为有利的生存（5 年 PFS，67%比 32%，P=0.050；5 年 OS，82%比 43%，P=0.030）。
结论
SNT-DLBCL 患者受益于利妥昔单抗和 CNS 导向化疗。
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