Jhatial Mussadique Ali, Khan Manzoor, Rab Saif Ur, Shaikh Naila, Loohana Chandumal, Imam Bokhari Syed W
Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.
Nuclear Medicine, Institution of Nuclear Medicine and Oncology, Lahore, PAK.
Cureus. 2021 Nov 18;13(11):e19699. doi: 10.7759/cureus.19699. eCollection 2021 Nov.
Background Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma with a five-year survival of 60%-70% with chemoimmunotherapy consisting of the R-CHOP combination (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone), with a relapse/refractory rate of 20-50%. Salvage therapy with HDT-ASCT is the treatment of choice for patients with relapsed/refractory disease with a success rate of 50%-60%. Patients who do not respond to the first salvage regimen or who relapsed after the first salvage regimen, with or without high-dose chemotherapy (HDT)-autologous stem cell transplantation (ASCT), have poor overall responses and survival and should be offered novel therapies. The objective of our study was to evaluate responses to second salvage, gemcitabine-based therapy with or without HDT-ASCT in a resource-limited setting. Materials and methods This was a retrospective study, including 55 patients aged >18 years, diagnosed with DLBCL and having received gemcitabine-based second salvage chemotherapy. Results The median age was 34 years, only one patient achieved progression-free survival (PFS) of >12 months with ORR of 27% to two cycles of gemcitabine-based combination, two years PFS and OS of 9.6% and 34%, respectively, and a median PFS and OS of four months and 13 months, respectively. Conclusion DLBCL patients, refractory to first-line and first salvage chemotherapy, should be considered for novel therapies or opt for palliative care rather than second salvage chemotherapy and HDT-ASCT, which results in poor overall response and significant toxicities.
弥漫性大B细胞淋巴瘤（DLBCL）是非霍奇金淋巴瘤最常见的亚型，采用利妥昔单抗、环磷酰胺、长春新碱、多柔比星和泼尼松组成的R-CHOP联合化疗免疫疗法，其五年生存率为60%-70%，复发/难治率为20%-50%。大剂量化疗联合自体干细胞移植（HDT-ASCT）的挽救治疗是复发/难治性疾病患者的首选治疗方法，成功率为50%-60%。对首个挽救方案无反应或在首个挽救方案后复发的患者，无论是否接受大剂量化疗（HDT）-自体干细胞移植（ASCT），其总体反应和生存率都较差，应提供新的治疗方法。我们研究的目的是在资源有限的环境中评估对第二次挽救治疗、基于吉西他滨的治疗（无论是否联合HDT-ASCT）的反应。材料和方法：这是一项回顾性研究，包括55名年龄大于18岁、诊断为DLBCL并接受基于吉西他滨的第二次挽救化疗的患者。结果：中位年龄为34岁，只有1名患者实现了超过12个月的无进展生存期（PFS），基于吉西他滨的联合治疗两个周期的客观缓解率（ORR）为27%，两年PFS和总生存期（OS）分别为9.6%和34%，中位PFS和OS分别为4个月和13个月。结论：对一线和首次挽救化疗难治的DLBCL患者，应考虑采用新的治疗方法或选择姑息治疗，而不是第二次挽救化疗和HDT-ASCT，因为后者总体反应较差且毒性显著。
