Paszkiewicz-Kozik Ewa, Debowska Malgorzata, Jakacka Natalia, Kotarska Martyna, Szymanski Marcin, Wisniewski Kamil, Konska Agnieszka, Jarzembowska Malgorzata, Drozd-Sokolowska Joanna, Romejko-Jarosinska Joanna, Szumera-Cieckiewicz Anna, Rymkiewicz Grzegorz, Ziarkiewicz-Wroblewska Bogna, Lech-Maranda Ewa, Walewski Jan, Hus Iwona
Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Department of Computational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Chemotherapy. 2022;67(4):201-210. doi: 10.1159/000523921. Epub 2022 Mar 4.
Follicular lymphoma (FL) is the most common type of indolent B-cell lymphoma with a favorable prognosis in the majority of patients. The induction treatment is still based on rituximab and chemotherapy, though new anti-CD20 antibody and chemo-free regimen have been recently introduced. The aim of the study was to analyze the management, outcomes, and determinants of prognosis of newly diagnosed patients with FL in real-world experience.
Data of consecutive patients diagnosed with FL in 5 years period (2011-2015) in three oncohematological centers were reviewed. Variables were compared using Mann-Whitney or χ2 test as appropriate, survival outpoints were calculated using Kaplan-Meier method.
One hundred eighty-one patients were included in the study. The median patients' age at diagnosis was 56.6 years. Low histological grade (G1-G2) was found in 62.1% of patients and advanced clinical stage in 77.0% of patients. ECOG 0 performance status was observed in 57.1% of patients. The median follow-up was 5.91 years. Initially, 31.5% of the patients were qualified to watch-and-wait (W&W) strategy, and 84.0% of the whole patients' group received systemic treatment during the observation period. As induction treatment, 53.9% and 41.4% of patients received RCVP and RCHOP regimens, respectively; 39.8% received rituximab maintenance (RM) after first-line therapy. During follow-up, transformation to aggressive lymphoma occurred in 7.2% of patients. Median overall survival (OS) was not achieved, and median progression-free survival (PFS) was 8.28 years (95% CI; 7.35, NA), 19.6% of patients relapsed during 24 months from the start of the treatment (POD24). Median PFS for POD24 group was 1.1 years (95% CI; 0.56, 1.45) with a median OS longer than 8 years. ECOG 0, low PRIMA PI, and no POD24 were found as determinants of longer PFS and OS.
Our data from clinical practice showed that rituximab and chemotherapy is still an effective method of FL treatment resulting in survival more than 8 years from diagnosis in most patients. RCVP protocol followed with RM is a reasonable choice for the first-line therapy especially in low/intermediate group of patients. The prognosis was significantly worse in patients with POD24. Therefore, searching for precise initial clinical and biological markers is warranted and development therapies to improve prognosis of POD24 patients.
滤泡性淋巴瘤（FL）是最常见的惰性B细胞淋巴瘤类型，大多数患者预后良好。尽管最近引入了新的抗CD20抗体和无化疗方案，但诱导治疗仍基于利妥昔单抗和化疗。本研究的目的是分析真实世界中初诊FL患者的治疗管理、结局及预后决定因素。
回顾了三个血液肿瘤中心在5年期间（2011 - 2015年）连续诊断为FL的患者数据。根据情况使用Mann-Whitney检验或χ2检验比较变量，采用Kaplan-Meier法计算生存终点。
181例患者纳入研究。诊断时患者的中位年龄为56.6岁。62.1%的患者为低组织学分级（G1-G2），77.0%的患者为晚期临床分期。57.1%的患者ECOG体能状态为0。中位随访时间为5.91年。最初，31.5%的患者符合观察等待（W&W）策略，整个患者组中84.0%在观察期内接受了全身治疗。作为诱导治疗，分别有53.9%和41.4%的患者接受了RCVP和RCHOP方案；39.8%的患者在一线治疗后接受了利妥昔单抗维持治疗（RM）。随访期间，7.2%的患者转化为侵袭性淋巴瘤。未达到中位总生存期（OS），中位无进展生存期（PFS）为8.28年（95%CI；7.35，NA），19.6%的患者在治疗开始后24个月内复发（POD24）。POD24组的中位PFS为1.1年（95%CI；0.56，1.45），中位OS超过8年。ECOG 0、低PRIMA PI和无POD24被发现是更长PFS和OS的决定因素。
我们来自临床实践的数据表明，利妥昔单抗和化疗仍然是FL治疗的有效方法，大多数患者自诊断起生存期超过8年。RCVP方案联合RM是一线治疗的合理选择，尤其是在低/中危组患者中。POD24患者的预后明显更差。因此，有必要寻找精确的初始临床和生物学标志物，并开发改善POD24患者预后的治疗方法。
