Sonnevi Kristina, Ljungqvist Maria, Jóelsson Jóel Kristinn, Harrysson Sara, Wästerlid Tove, Bernell Per, Wahlin Björn Engelbrekt
Haematology Medical Unit Karolinska University Hospital Stockholm Sweden.
Division of Haematology, Department of Medicine, Huddinge Karolinska Institutet Stockholm Sweden.
EJHaem. 2021 Sep 28;2(4):774-784. doi: 10.1002/jha2.296. eCollection 2021 Nov.
Patients with high-risk aggressive B-cell lymphoma exhibit poor survival after R-CHOP. More intensive regimens yield higher rates of remission but also of complication. We investigated all 401 patients < 70 years with high-risk (age-adjusted [aa] international prognostic index [IPI] ≥2, extranodal, or bulky) aggressive B-cell lymphoma hospitalized at Karolinska for urgent start of immunochemotherapy (129 R-Hyper-CVAD; 261 R-CHOP/R-CHOEP). Patients showed IPI 3-5 (70%), WHO PS ≥2 (49%), bulky disease (70%), extranodal (75%) and CNS (8%) involvement. Five-year overall/progression-free survival (OS/PFS) was better in patients who started R-Hyper-CVAD (84%/77%) compared with R-CHOP/R-CHOEP (66%/55%). Differences were independent in multivariable analysis, seen in all patient categories, and accentuated in extreme high-risk disease: R-Hyper-CVAD vs. R-CHOP/R-CHOEP showed 5-year PFS 69% vs.40% in aaIPI 3 and 88% vs. 38% in CNS involvement. For validation, survival was compared between the two Karolinska sites and calendar periods. Survival was superior 2006-2010 at the site that introduced R-Hyper-CVAD/R-MA 2006, identical at both sites 2011-2017 after the other site adopted R-Hyper-CVAD/R-MA 2011, and excellent 2018-2020 when R-Hyper-CVAD/R-MA use increased to 75% of patients. Despite considerable toxicity, also patients aged 61-69 years showed better survival with R-Hyper-CVAD/R-MA. This is the largest single-centre series of patients treated with R-Hyper-CVAD/R-MA, showing favourable outcome in high-risk aggressive B-cell lymphoma.
高危侵袭性B细胞淋巴瘤患者在接受R-CHOP治疗后生存率较低。更强化的治疗方案缓解率更高，但并发症发生率也更高。我们调查了卡罗林斯卡医院收治的所有401例年龄小于70岁的高危（年龄校正国际预后指数[IPI]≥2、结外或大包块）侵袭性B细胞淋巴瘤患者，这些患者因急需开始免疫化疗而住院（129例接受R-Hyper-CVAD；261例接受R-CHOP/R-CHOEP）。患者的IPI为3-5（70%），世界卫生组织体能状态评分（WHO PS）≥2（49%），有大包块病变（70%），结外受累（75%），中枢神经系统受累（8%）。与接受R-CHOP/R-CHOEP治疗的患者（66%/55%）相比，开始接受R-Hyper-CVAD治疗的患者5年总生存率/无进展生存率（OS/PFS）更高（84%/77%）。在多变量分析中，差异具有独立性，在所有患者类别中均可见，在极高危疾病中更为明显：在年龄校正IPI为3的患者中，R-Hyper-CVAD与R-CHOP/R-CHOEP相比，5年无进展生存率分别为69%和40%；在中枢神经系统受累的患者中，分别为88%和38%。为了进行验证，我们比较了卡罗林斯卡医院两个院区以及不同时间段的生存率。在2006年引入R-Hyper-CVAD/R-MA的院区，2006-2010年生存率更高；在另一个院区于2011年采用R-Hyper-CVAD/R-MA后，2011-2017年两个院区的生存率相同；在2018-2020年，当R-Hyper-CVAD/R-MA的使用比例增加到75%的患者时，生存率极佳。尽管毒性较大，但61-69岁的患者接受R-Hyper-CVAD/R-MA治疗后生存率也更高。这是接受R-Hyper-CVAD/R-MA治疗的患者中最大的单中心系列研究，显示出高危侵袭性B细胞淋巴瘤患者的良好预后。
