原发性或继发性转化惰性 B 细胞淋巴瘤患者的治疗结果。

Treatment Outcome in Patients with Primary or Secondary Transformed Indolent B-Cell Lymphomas.

机构信息

Department of Hematology, University Hospital Essen, West German Cancer Center, University of Duisburg-Essen, Essen, Germany.

Department of Medical Oncology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany.

出版信息

Oncol Res Treat. 2019;42(11):580-588. doi: 10.1159/000502754. Epub 2019 Sep 19.

DOI:10.1159/000502754

PMID:31536987

Abstract

BACKGROUND

Histologic transformation (HT) of indolent B-cell lymphomas into an aggressive form can occur simultaneously (primary HT, pHT) or sequentially after a preceding diagnosis of indolent lymphoma (secondary HT, sHT). The clinical course after diagnosis of HT is variable.

OBJECTIVES

To describe the outcome of treatment in pHT and sHT patients.

METHODS

We retrospectively analyzed HT cases with an underlying follicular lymphoma, nodal marginal zone lymphoma, extranodal marginal zone lymphoma, lymphoplasmacytic lymphoma, or small lymphocytic lymphoma at our institution. Kaplan-Meier estimates were used to calculate progression-free survival (PFS) and overall survival (OS).

RESULTS

Ninety-two HT patients were identified, 38 with pHT and 54 with sHT. In sHT, time-to-transformation was not influenced by the preceding treatment strategy of the indolent lymphoma component. In pHT, median PFS was 61 months (95% CI 27-61), and OS was not reached. In sHT, median PFS and OS was 14 months (95% CI 9-32) and 42 months (95% CI 16-90), respectively. Significant differences between pHT and sHT in PFS (p = 0.002; Hazard ratio [HR] 2.30, 95% CI 1.36-3.91) and OS (p = 0.0001; HR 3.30, 95% CI 1.81-6.03) were observed. Response to treatment for transformation was highly prognostic of PFS and OS (p < 0.0001).

CONCLUSIONS

The outcome in pHT cases is favorable and signifi-cantly better than in sHT cases. Failure to achieve a remission after treatment for transformation confers a dismal pro-gnosis.

摘要

背景

惰性 B 细胞淋巴瘤向侵袭性形式的组织学转化（HT）可同时发生（原发性 HT，pHT）或在先前诊断为惰性淋巴瘤后顺序发生（继发性 HT，sHT）。诊断为 HT 后的临床病程是可变的。

目的

描述 pHT 和 sHT 患者治疗的结果。

方法

我们回顾性分析了我院滤泡性淋巴瘤、结外边缘区淋巴瘤、结内边缘区淋巴瘤、黏膜相关淋巴组织边缘区淋巴瘤或小淋巴细胞淋巴瘤的 HT 病例。Kaplan-Meier 估计用于计算无进展生存期（PFS）和总生存期（OS）。

结果

共确定了 92 例 HT 患者，其中 38 例为 pHT，54 例为 sHT。在 sHT 中，转化前的惰性淋巴瘤成分的治疗策略并不影响转化时间。在 pHT 中，中位 PFS 为 61 个月（95%CI 27-61），OS 未达到。在 sHT 中，中位 PFS 和 OS 分别为 14 个月（95%CI 9-32）和 42 个月（95%CI 16-90）。pHT 和 sHT 在 PFS（p=0.002；危险比[HR]2.30，95%CI 1.36-3.91）和 OS（p=0.0001；HR 3.30，95%CI 1.81-6.03）方面存在显著差异。对转化治疗的反应高度预测 PFS 和 OS（p<0.0001）。