Deparment of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Division of General Internal Medicine and Health Services Research, Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Hematol Oncol. 2020 Feb;38(1):38-50. doi: 10.1002/hon.2690. Epub 2019 Dec 3.
While various tools such as the International Prognostic Index (IPI) and its derivatives exist for risk-stratification of diffuse large B-cell lymphoma (DLBCL) at diagnosis, patient and disease characteristics capable of predicting outcome after high-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT) are not clearly defined. We retrospectively analyzed medical records of 111 DLBCL patients (78 relapsed and 33 refractory) who underwent HDC/ASCT at our institution from 2010-2015. After a median follow-up time of 4.6 years (interquartile range [IQR] 2.2-8.1), the likelihood of 5-year progression-free survival (PFS) was 62.2% (95% CI, 53.4%-72.4%) and the likelihood of 5-year overall survival (OS) was 68.9% (95% CI, 60.7%-78.2%). More than three chemotherapy regimens prior to ASCT was the only variable associated with lower likelihood of PFS (P = .004) and OS (P = 0.026). Male gender and high IPI score at time of ASCT were also associated with lower likelihood of PFS (P = .043; P = .013). NCCN IPI and age-adjusted IPI at time of ASCT were not predictive of outcome following ASCT. Patients with refractory and relapsed disease had similar outcomes post-ASCT (P = .207 for PFS, P = .073 for OS).
虽然目前存在国际预后指数（IPI）及其衍生工具等多种工具，可用于对弥漫性大 B 细胞淋巴瘤（DLBCL）患者进行诊断时的风险分层，但能够预测接受大剂量化疗联合自体造血干细胞移植（HDC/ASCT）后的结局的患者和疾病特征尚不清楚。我们回顾性分析了 2010 年至 2015 年期间在我院接受 HDC/ASCT 的 111 例 DLBCL 患者（78 例复发和 33 例难治）的病历。中位随访时间为 4.6 年（四分位距[IQR]：2.2-8.1），5 年无进展生存（PFS）率为 62.2%（95%CI：53.4%-72.4%），5 年总生存（OS）率为 68.9%（95%CI：60.7%-78.2%）。ASCT 前接受超过三种化疗方案是与较低的 PFS （P =.004）和 OS （P = 0.026）可能性相关的唯一变量。ASCT 时的男性性别和较高的 IPI 评分也与较低的 PFS （P =.043；P =.013）可能性相关。ASCT 时的 NCCN IPI 和年龄调整后的 IPI 对 ASCT 后的结果没有预测作用。难治性和复发性疾病患者在接受 ASCT 后具有相似的结局（PFS 为 P =.207，OS 为 P =.073）。
