Kiesewetter Barbara, Simonitsch-Klupp Ingrid, Mayerhoefer Marius E, Dolak Werner, Lukas Julius, Raderer Markus
Department of Medicine I, Division of Oncology, Medical University of Vienna, A-1090 Vienna, Austria.
Department of Pathology, Medical University of Vienna, A-1090 Vienna, Austria.
Cancers (Basel). 2020 Nov 26;12(12):3533. doi: 10.3390/cancers12123533.
There is no clear therapeutic algorithm for mucosa-associated lymphoid tissue (MALT) lymphoma beyond Helicobacter pylori eradication and while chemotherapy-based regimens are standard for MALT lymphoma patients in need of systemic treatment, it appears of interest to also investigate chemotherapy-free strategies. We have retrospectively assessed MALT lymphoma patients undergoing upfront systemic treatment, classified either as chemotherapy (=classical cytostatic agents +/- rituximab) or immunotherapy (=immunomodulatory agents or single anti-CD20 antibodies) at the Medical University Vienna 1999-2019. The primary endpoint was progression-free survival (PFS). In total, 159 patients were identified with a median follow-up of 67 months. The majority of patients had extragastric disease (80%), but we also identified 32 patients (20%) with Helicobacter pylori negative or disseminated gastric lymphoma. Regarding the type of first line treatment and outcome, 46% (74/159) received a chemotherapy-based regimen and 54% (85/159) immunotherapy including IMiDs lenalidomide/thalidomide (37%), anti-CD20-anitbodies rituximab/ofatumumab (27%), macrolides clarithromycin/azithromycin (27%) and proteasome inhibitor bortezomib (9%). Median PFS was 76 months (95%CI 50-102), and while the overall response (90% vs. 68%, 0.01) and the complete remission rate (75% vs. 43%, 0.01) was significantly higher for chemotherapy, there was no difference in PFS between chemotherapy (median 81 months, 95%CI 47-116) and immunotherapy (76 months, 95%CI 50-103, = 0.57), suggesting comparable long-term outcomes. To conclude, our data show higher response rates with chemo- compared to immunotherapy, but this did not translate into a superior PFS. Given the biological background of MALT lymphoma, and the favorable toxicity profile of novel immunomodulatory treatments, this should be further investigated.
除了根除幽门螺杆菌外，黏膜相关淋巴组织（MALT）淋巴瘤尚无明确的治疗方案。虽然基于化疗的方案是需要进行全身治疗的MALT淋巴瘤患者的标准治疗方法，但研究无化疗策略似乎也很有意义。我们回顾性评估了1999年至2019年在维也纳医科大学接受一线全身治疗的MALT淋巴瘤患者，这些患者被分类为接受化疗（即经典细胞抑制剂+/-利妥昔单抗）或免疫治疗（即免疫调节剂或单克隆抗CD20抗体）。主要终点是无进展生存期（PFS）。总共确定了159例患者，中位随访时间为67个月。大多数患者有胃外疾病（80%），但我们也确定了32例（20%）幽门螺杆菌阴性或弥漫性胃淋巴瘤患者。关于一线治疗类型和结果，46%（74/159）接受了基于化疗的方案，54%（85/159）接受了免疫治疗，包括免疫调节剂来那度胺/沙利度胺（37%）、抗CD20抗体利妥昔单抗/奥法木单抗（27%）、大环内酯类克拉霉素/阿奇霉素（27%）和蛋白酶体抑制剂硼替佐米（9%）。中位PFS为76个月（95%CI 50-102），虽然化疗的总体缓解率（90%对68%，P=0.01）和完全缓解率（75%对43%，P=0.01）显著更高，但化疗（中位81个月，95%CI 47-116）和免疫治疗（76个月，95%CI 50-103，P=0.57）之间的PFS没有差异，表明长期结果相当。总之，我们的数据显示化疗的缓解率高于免疫治疗，但这并没有转化为更好的PFS。鉴于MALT淋巴瘤的生物学背景以及新型免疫调节治疗良好的毒性特征，这一点应进一步研究。
