Procházka Vít, Belada David, Janíková Andrea, Benešová Kateřina, Mociková Heidi, Ďuraš Juraj, Pirnos Jan, Kopečková Kateřina, Campr Vít, Fürst Tomáš, Pytlík Robert, Sýkorová Alice, Michalka Jozef, Dlouhá Jitka, Papajík Tomáš, Trněný Marek
Department of Hemato-Oncology, Faculty of Medicine and Dentistry University Hospital in Olomouc Olomouc Czech Republic.
Fourth Department of Internal Medicine - Hematology University Hospital Hradec Králové Czech Republic.
EJHaem. 2020 Jul 31;1(1):170-180. doi: 10.1002/jha2.60. eCollection 2020 Jul.
Twenty percent of patients with high-tumor-burden (HTB) follicular lymphoma (FL) develop progression/relapse of disease (POD) within 24 months of frontline immunochemotherapy. Unfortunately, about 50% of these patients die within 5 years since POD event. Rituximab maintenance was proven to reduce relapse rate in responding FL, but its role on preventing POD was not defined. We analyzed 1360 HTB-FL patients from the Czech Lymphoma Study Group registry treated with frontline rituximab-containing regimen. Of those, 950 cases received rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and achieved complete or partial remission: 712 patients received rituximab maintenance (MAINT) and 238 were a historical observational cohort (OBS). We have proposed a modified POD24 (mPOD24) endpoint for the chemosensitive patients calculated from the end-of-induction (EOI). Survival rates since EOI were as follows: 5-year overall survival (OS) 86.2% versus 94.5% in the OBS and MAINT groups, respectively ( < .001) and 5-year progression-free survival 58.5% (OBS) and 75.4% (MAINT) ( < .001). The Cox proportional hazards model showed a decrease in mPOD24 incidence in the MAINT group with the overall hazard rate reduced by 56% (hazard ratio = 0.44; < .001). The cumulative incidence of mPOD24 was reduced from 24.1% in OBS to 10.1% in MAINT ( < .001). Comparison of non-mPOD24 cases showed OS similar to that in the general population. Rituximab maintenance given after R-CHOP resulted in a 2.4-fold reduction in mPOD24 incidence. Once the non-POD24 status is achieved, FL does not shorten the patients' life expectancy.
20%的高肿瘤负荷（HTB）滤泡性淋巴瘤（FL）患者在一线免疫化疗的24个月内会出现疾病进展/复发（POD）。不幸的是，这些患者中约50%在POD事件发生后的5年内死亡。利妥昔单抗维持治疗已被证明可降低反应性FL的复发率，但其在预防POD方面的作用尚未明确。我们分析了来自捷克淋巴瘤研究组登记处的1360例接受含利妥昔单抗一线方案治疗的HTB-FL患者。其中，950例患者接受了利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）治疗并实现了完全或部分缓解：712例患者接受了利妥昔单抗维持治疗（MAINT），238例为历史观察队列（OBS）。我们为化疗敏感患者提出了一种从诱导结束（EOI）计算的改良POD24（mPOD24）终点。自EOI以来的生存率如下：5年总生存率（OS）在OBS组和MAINT组分别为86.2%和94.5%（P<0.001），5年无进展生存率在OBS组为58.5%，在MAINT组为75.4%（P<0.001）。Cox比例风险模型显示MAINT组中mPOD24的发生率降低，总体风险率降低了56%（风险比=0.44；P<0.001）。mPOD24的累积发生率从OBS组的24.1%降至MAINT组的10.1%（P<0.001）。非mPOD24病例的比较显示其OS与一般人群相似。R-CHOP后给予利妥昔单抗维持治疗使mPOD24的发生率降低了2.4倍。一旦达到非POD24状态，FL不会缩短患者的预期寿命。
