Haematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy.
Br J Haematol. 2020 Jan;188(2):249-258. doi: 10.1111/bjh.16125. Epub 2019 Aug 5.
Since 2000, we have investigated 67 consecutive patients with stage I/II follicular lymphoma (FL) for the presence of BCL2/IGH rearrangements by polymerase chain reaction (PCR), real time quantitative PCR (RQ-PCR) and digital droplet PCR (ddPCR). All patients were treated with involved-field radiotherapy (IF-RT) (24-30 Gy). From 2005, patients with minimal residual disease (MRD) after IF-RT received rituximab (R) (375 mg/m , 4 weekly administrations). The median follow-up is 82 months (17-196). At diagnosis, 72% of patients were BCL2/IGH+. Progression-free survival (PFS) was significantly better in patients with undetectable/low levels (<10 ) of circulating BCL2/IGH+ cells at diagnosis and in those who were persistently MRD- during follow-up (P = 0·0038). IF-RT induced an MRD- status in 50% of cases; 16/19 (84%) MRD+ patients after IF-RT became MRD- after R treatment. A significantly longer PFS was observed in MRD+ patients treated with R compared to untreated MRD+ patients (P = 0·049). In early stage FL, both circulating levels of BCL2/IGH+ cells at diagnosis and MRD status during follow-up bear prognostic implications. Standard IF-RT fails to induce an MRD-negative status in half of patients. Most patients become MRD- following treatment with R and this is associated with a significantly better PFS.
自 2000 年以来，我们通过聚合酶链反应（PCR）、实时定量 PCR（RQ-PCR）和数字液滴 PCR（ddPCR）连续研究了 67 例 I/II 期滤泡淋巴瘤（FL）患者，以检测 BCL2/IGH 重排。所有患者均接受累及野放疗（IF-RT）（24-30 Gy）。从 2005 年开始，接受 IF-RT 后有微小残留病灶（MRD）的患者接受利妥昔单抗（R）（375mg/m ，每周 4 次）治疗。中位随访时间为 82 个月（17-196）。在诊断时，72%的患者 BCL2/IGH+。在诊断时循环 BCL2/IGH+细胞水平不可检测/低水平（<10 ）和随访期间持续 MRD-的患者无进展生存（PFS）显著更好（P=0.0038）。IF-RT 可使 50%的病例达到 MRD-状态；19 例 IF-RT 后 MRD+患者中的 16 例（84%）在接受 R 治疗后成为 MRD-。与未经治疗的 MRD+患者相比，接受 R 治疗的 MRD+患者的 PFS 显著更长（P=0.049）。在早期 FL 中，诊断时循环 BCL2/IGH+细胞水平和随访期间的 MRD 状态均具有预后意义。标准 IF-RT 无法使一半的患者达到 MRD-状态。大多数患者在接受 R 治疗后成为 MRD-，这与显著更好的 PFS 相关。
