Servicio de Hematología e Investigación Clínica, Fundación para Combatir la Leucemia (FUNDALEU), Buenos Aires, Argentina.
CEPHO/ABC School of Medicine, Santo André, Brazil.
JCO Glob Oncol. 2022 Mar;8:e2100265. doi: 10.1200/GO.21.00265.
Real-world evidence on non-Hodgkin lymphoma (NHL) management in Latin America is currently lacking. The objective of this study was to describe treatment characteristics and outcomes of NHL in Latin America.
A total of 2,967 patients with NHL with aggressive and indolent subtypes, including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle-cell lymphoma (MCL), and mucosa-associated lymphoid tissue (MALT) lymphoma, with incident or prevalent diagnosis between 2006 and 2015, were retrospectively identified using clinical charts registered in the Hemato-Oncology Latin America Observational Registry. Associations between treatment regimen and age at diagnosis with clinical outcomes within each subtype were estimated using Cox proportional hazard regression.
Most patients with NHL received 1L chemoimmunotherapy, most commonly cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with/without rituximab. Five-year survival rates were higher for MALT lymphoma (90.8%) and FL (87.6%) versus DLBCL (69.0%) and MCL (57.1%), with variations between countries. The median overall survival from first relapse for patients with DLBCL was 6.6 years, with lower risk of death for those diagnosed at age < 65 years (hazard ratio = 0.732; = .0161). Patients achieved a longer median progression-free survival with 1L rituximab-CHOP (R-CHOP) versus CHOP or rituximab, cyclophosphamide, vincristine, and prednisone (RCVP) (7.7 3.0 or 1.8 years, respectively). Use of regimens other than R-CHOP was associated with a higher risk of death/progression for patients with DLBCL (rituximab, ifosfamide, carboplatin, and etoposide/ifosfamide, carboplatin, and etoposide) and FL (CHOP). There was no relationship between treatment prescribed and age at diagnosis with outcomes from first/second relapse in DLBCL and FL.
Differences in treatment outcomes between NHL subtypes were observed, reflecting variations in NHL management and barriers to treatment access in Latin America. These data provide necessary evidence to understand NHL management in this region and highlight the need to improve treatment outcomes for these patients.
目前缺乏拉丁美洲关于非霍奇金淋巴瘤（NHL）管理的真实世界证据。本研究的目的是描述拉丁美洲 NHL 的治疗特征和结局。
使用 Hemato-Oncology Latin America Observational Registry 中注册的临床病历，回顾性地确定了 2006 年至 2015 年间患有侵袭性和惰性亚型 NHL（包括弥漫性大 B 细胞淋巴瘤[DLBCL]、滤泡性淋巴瘤[FL]、套细胞淋巴瘤[MCL]和黏膜相关淋巴组织[MALT]淋巴瘤）的 2967 例患者的发病或确诊情况。使用 Cox 比例风险回归估计每种亚型中治疗方案与诊断时年龄与临床结局之间的关联。
大多数 NHL 患者接受了 1 线化疗免疫治疗，最常见的是环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP）联合/不联合利妥昔单抗。MALT 淋巴瘤（90.8%）和 FL（87.6%）的 5 年生存率高于 DLBCL（69.0%）和 MCL（57.1%），各国之间存在差异。DLBCL 患者首次复发后的中位总生存期为 6.6 年，<65 岁诊断的患者死亡风险较低（风险比=0.732；P=0.0161）。与 CHOP 或利妥昔单抗、环磷酰胺、长春新碱和泼尼松（RCVP）相比，1 线利妥昔单抗-CHOP（R-CHOP）可使患者获得更长的中位无进展生存期（分别为 7.7 年、3.0 年和 1.8 年）。对于 DLBCL（利妥昔单抗、异环磷酰胺、卡铂和依托泊苷/异环磷酰胺、卡铂和依托泊苷）和 FL（CHOP）患者，使用 R-CHOP 以外的方案与死亡/进展风险增加相关。在 DLBCL 和 FL 中，首次/二次复发的治疗方案与诊断时年龄与结局之间没有关系。
观察到 NHL 亚型之间的治疗结果存在差异，这反映了拉丁美洲 NHL 管理的差异以及治疗的障碍。这些数据提供了了解该地区 NHL 管理的必要证据，并强调需要改善这些患者的治疗结果。
