Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Department of Hematology Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan.
Sci Rep. 2021 May 12;11(1):10069. doi: 10.1038/s41598-021-89316-y.
Complete disease journey and risk factors for poor outcomes are needed to facilitate effectiveness evaluations of new therapies and clinical decision-making in B-cell Non-Hodgkin lymphoma (B-NHL), particularly in Asia where such data are lacking. This retrospective cohort study used electronic medical records from a regional medical centre in southern Taiwan to follow-up 441 patients newly diagnosed with common B-NHL subtypes: Diffuse Large B-cell Lymphoma (DLBCL), Follicular Lymphoma (FL), Chronic Lymphocytic Leukaemia/Small Lymphocytic Lymphoma (CLL/SLL), Marginal Zone Lymphoma (MZL), Mantle Cell Lymphoma (MCL), and Waldenström macroglobulinemia (WM), between 01-Jan-2008 and 31-Dec-2013, until 31-Dec-2017. Treatment pathways were modelled using a Markov approach. Stage III/IV disease at diagnosis was frequent for patients with DLBCL, FL, MCL and WM. Hepatitis B surface antigen/hepatitis C virus seropositivity was 18.6%/12.3%. Clinical responses to 1st-line treatment were observed in 76.0% (DLBCL), 87.3% (FL), 86.0% (MZL), 60.0% (MCL), and 42.9% (WM) of patients. For DLBCL, disease control was achieved by ~ 50% after 1st-line, ~ 24% after 2nd-line, ~ 17% after 3rd-line. Patients with Stage III/IV DLBCL or age > 65 years at diagnosis had lower rates of active treatment, poorer disease control and higher mortality than patients with early stage disease or age ≤ 65 years. Disease flare < 6 months after 1st-line treatment was significantly associated with mortality. Despite good clinical response rates for some sub-types, survival remains poor. New treatments are needed to improve the outcome of B-NHL.
需要了解完整的疾病进程和不良预后的风险因素，以促进新疗法在 B 细胞非霍奇金淋巴瘤（B-NHL）中的有效性评估和临床决策，特别是在亚洲，缺乏此类数据。这项回顾性队列研究使用了台湾南部一家地区医疗中心的电子病历，对 441 例新诊断为常见 B-NHL 亚型的患者进行了随访：弥漫性大 B 细胞淋巴瘤（DLBCL）、滤泡性淋巴瘤（FL）、慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）、边缘区淋巴瘤（MZL）、套细胞淋巴瘤（MCL）和华氏巨球蛋白血症（WM），随访时间从 2008 年 1 月 1 日至 2013 年 12 月 31 日，直至 2017 年 12 月 31 日。治疗途径采用马尔可夫方法进行建模。诊断时患有 III/IV 期疾病的患者多见于 DLBCL、FL、MCL 和 WM。乙型肝炎表面抗原/丙型肝炎病毒阳性率分别为 18.6%和 12.3%。观察到 76.0%（DLBCL）、87.3%（FL）、86.0%（MZL）、60.0%（MCL）和 42.9%（WM）的患者对一线治疗有临床反应。对于 DLBCL，一线治疗后约 50%、二线治疗后约 24%、三线治疗后约 17%实现疾病控制。诊断时患有 III/IV 期 DLBCL 或年龄>65 岁的患者，与早期疾病或年龄≤65 岁的患者相比，接受积极治疗的比例较低，疾病控制较差，死亡率较高。一线治疗后疾病复发<6 个月与死亡率显著相关。尽管某些亚型的临床缓解率较高，但生存情况仍然较差。需要新的治疗方法来改善 B-NHL 的预后。
