Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany.
University Clinic for Radiotherapy and Radiooncology, Pius-Hospital Oldenburg, Oldenburg, Germany.
Strahlenther Onkol. 2022 Jan;198(1):39-46. doi: 10.1007/s00066-021-01868-0. Epub 2021 Nov 4.
The prognosis of an early relapse of diffuse large B-cell lymphoma (DLBCL) appears to be poor following autologous stem cell transplantation (ASCT). The aim of this study is to contribute data to the open question on whether additional radiotherapy can improve the outcome.
Forty-eight patients with an early relapse (median 4 months after the end of initial immunochemotherapy, range 1-11) of DLBCL have been treated in our institution with high-dose therapy (usually the BEAM protocol) and ASCT since 2008 (median age 61 years, range 28-73). Twenty-three patients received ASCT in a second treatment line, 25 in a third line (19 refractory to second-line salvage therapy, 5 after second relapse). Fifteen of these 48 patients received radiotherapy (36-50 Gy, median 40) of residual masses after ASCT.
Three-year overall survival (OS) and progression-free survival (PFS) after second-line ASCT were 61 and 57%, after third-line ASCT 47 and 44%, respectively, without significant differences. A prognostic factor was the International Prognostic Index (IPI) at the start of salvage therapy. Three-year OS and PFS in low-risk patients were 69 and 69%, in low-intermediate-risk 63 and 53%, and in high-intermediate-risk 23 and 23%, respectively (p = 0.033). Twenty-three patients achieved a sustained complete remission (13-146 months, median 62).
Sustained long-term remissions can be achieved in patients with early relapse of DLBCL following ASCT in a second or third treatment line, particularly in patients with low- and low-intermediate-risk IPI, following radiotherapy of residual disease after ASCT. Further investigations are required to clarify which patients need an alternative therapy (potentially CAR T‑cells or allogeneic transplantation).
自体造血干细胞移植（ASCT）后，弥漫性大 B 细胞淋巴瘤（DLBCL）早期复发的预后似乎较差。本研究旨在为 ASCT 后是否需要额外放疗来改善预后这一开放性问题提供数据支持。
自 2008 年以来，我们机构对 48 例 DLBCL 早期复发（初始免疫化疗结束后中位数为 4 个月，范围为 1-11 个月）的患者进行了高剂量治疗（通常采用 BEAM 方案）和 ASCT。患者中位年龄为 61 岁（范围为 28-73 岁）。23 例患者在二线治疗中接受 ASCT，25 例患者在三线治疗中接受 ASCT（19 例对二线挽救治疗耐药，5 例为二线复发后）。这 48 例患者中有 15 例在 ASCT 后接受了残留肿块的放疗（36-50Gy，中位数为 40Gy）。
二线 ASCT 后 3 年的总生存率（OS）和无进展生存率（PFS）分别为 61%和 57%，三线 ASCT 后分别为 47%和 44%，无显著差异。预后因素为挽救治疗开始时的国际预后指数（IPI）。低危患者的 3 年 OS 和 PFS 分别为 69%和 69%，低中危患者分别为 63%和 53%，高中危患者分别为 23%和 23%（p=0.033）。23 例患者获得持续完全缓解（13-146 个月，中位数 62 个月）。
在二线或三线治疗中，ASCT 后早期复发的 DLBCL 患者可获得持续的长期缓解，尤其是在 ASCT 后残留疾病放疗后 IPI 为低危和低中危的患者。需要进一步研究来明确哪些患者需要替代治疗（可能是 CAR T 细胞或异基因移植）。
