Igor Aurer, Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia,
Croat Med J. 2021 Oct 31;62(5):455-463. doi: 10.3325/cmj.2021.62.455-63.
To compare the outcomes of Croatian patients with mantle cell lymphoma (MCL) who started treatment in 2007 and 2008 (historical cohort) and of those who started treatment between 2015 and 2017 (recent cohort).
The historical cohort consisted of 40 patients who started treatment with rituximab in 2007 and 2008. Data on the recent cohort, consisting of 89 patients, were collected retrospectively from the electronic databases of Croatian hospitals with hematology units. Demographic characteristics and data on induction regimens, autologous stem cell transplantation (ASCT), and rituximab maintenance in the first remission, event-free survival (EFS), and overall survival (OS) were available for both cohorts, and data on cell morphology, mantle cell international prognostic index (MIPI), and Ki67 expression only for the recent cohort.
The recent cohort had significantly better two-year EFS and OS (EFS 58% vs 40%, P=0.014; OS 80% vs 56%, P=0.009), especially in patients below 65. In univariate analysis, induction regimen, ASCT, and maintenance were significant prognostic factors for EFS and the former two for OS. In the multivariate analysis, only ASCT remained significant. Bendamustine+rituximab (BR) induction improved the outcomes of non-transplantable patients over R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, steroid). Blastoid morphology and high MIPI were adverse prognostic factors for EFS and OS.
In the last decade, the outcome of newly diagnosed MCL patients improved. ASCT in the first remission was the main contributor in transplantable patients and BR in non-transplantable. Regularly updated national guidelines may help in a timely adoption of new treatments, thus improving the results.
比较于 2007 年和 2008 年（历史队列）开始治疗的克罗地亚套细胞淋巴瘤（MCL）患者与 2015 年至 2017 年（近期队列）开始治疗的患者的结局。
历史队列由 40 名于 2007 年和 2008 年接受利妥昔单抗治疗的患者组成。回顾性地从克罗地亚具有血液学单位的医院的电子数据库中收集了 89 例近期队列患者的数据。两组均有患者的人口统计学特征和诱导方案、自体干细胞移植（ASCT）以及首次缓解时的利妥昔单抗维持、无事件生存（EFS）和总生存（OS）的数据，而近期队列则有细胞形态学、套细胞国际预后指数（MIPI）和 Ki67 表达的数据。
近期队列的两年 EFS 和 OS 明显更好（EFS 58% vs 40%，P=0.014；OS 80% vs 56%，P=0.009），尤其是 65 岁以下患者。在单因素分析中，诱导方案、ASCT 和维持是 EFS 的重要预后因素，前两者是 OS 的重要预后因素。在多因素分析中，只有 ASCT 仍然是重要因素。BR 诱导方案优于 R-CHOP（利妥昔单抗、环磷酰胺、阿霉素、长春新碱、强的松）可改善不能移植患者的预后。母细胞样形态和高 MIPI 是 EFS 和 OS 的不良预后因素。
在过去十年中，新诊断的 MCL 患者的结局得到改善。ASCT 是可移植患者的主要治疗方法，BR 是不可移植患者的主要治疗方法。定期更新的国家指南可能有助于及时采用新的治疗方法，从而改善结果。
