Lin Z J, Zha J, Yi S H, Li Z F, Ping L Y, He X H, Yu H F, Zheng Z, Xu W, Chen F L, Xie Y, Chen B Y, Zhang H L, Wang L, Ding K Y, Li W Y, Yang H Y, Zhao W L, Qiu L G, Li Z M, Song Y Q, Xu B
Department of Hematology, the First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen 361003, China.
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2022 Jun 14;43(6):456-462. doi: 10.3760/cma.j.issn.0253-2727.2022.06.003.
To explore the clinical features and survival of newly diagnosed follicular lymphoma (FL) patients with diffuse large B-cell lymphoma (DLBCL) component. 1845 newly diagnosed FL patients aged ≥ 18 years with grades 1-3a in 11 medical centers in China from 2000 to 2020 were included, and patients with DLBCL component were screened. The clinical data and survival data of the patients were retrospectively analyzed, and the prognostic factors were screened by univariate and multivariate analysis. 146 patients (7.9% ) with newly diagnosed FL had DLBCL component. The median age was 56 (25-83) years, 79 males (54.1% ) . The pathology of 127 patients showed the proportion of DLBCL component. Patients were divided into two groups according to whether the proportion of DLBCL component was ≥ 50% . The study found that patients with DLBCL component ≥ 50% had higher grade 3 ratio (94.3% 91.9% , =0.010) , Ki-67 index ≥ 70% ratio (58.5% 32.9% , =0.013) and PET-CT SUVmax ≥ 13 ratio (72.4% 46.3% , =0.030) than patients with DLBCL component<50% . All patients received CHOP or CHOP like ± rituximab chemotherapy. The overall response rate (ORR) was 88.2% , and the complete response (CR) rate was 76.4% . In the groups with different proportions of DLBCL component, there was no significant difference in the remission rate after induction treatment and the incidence of disease progression within 2 years after initiation of treatment (POD24) (<0.05) . The overall estimated 5-year progression free survival (PFS) rate was 58.9% , and the 5-year overall survival (OS) rate was 90.4% . The 5-year OS rate of POD24 patients was lower than that of non POD24 patients (70.3% 98.5% , <0.001) . Compared with non maintenance treatment of rituximab, maintenance treatment of rituximab could not benefit the 5-year PFS rate (57.7% 58.8% , =0.543) , and the 5-year OS rate had a benefit trend, but the difference was not statistically significant (100% 87.8% , =0.082) . Multivariate analysis showed that failure to reach CR after induction treatment was an independent risk factor for PFS (=0.006) , while LDH higher than normal was an independent risk factor for OS (=0.031) . FL patients with DLBCL component ≥50% have more invasive clinical and pathological features. CHOP/CHOP like ± rituximab regimen can improve the clinical efficacy of patients. Rituximab maintenance therapy can not benefit the PFS and OS of patients. Failure to reach CR after induction therapy was the independent unfavorable factor for PFS.
探索新诊断的伴有弥漫性大B细胞淋巴瘤（DLBCL）成分的滤泡性淋巴瘤（FL）患者的临床特征及生存情况。纳入2000年至2020年期间中国11家医疗中心的1845例年龄≥18岁、1-3a级的新诊断FL患者，并筛选出伴有DLBCL成分的患者。对患者的临床资料和生存数据进行回顾性分析，并通过单因素和多因素分析筛选预后因素。146例（7.9%）新诊断的FL患者伴有DLBCL成分。中位年龄为56（25-83）岁，男性79例（54.1%）。127例患者的病理显示了DLBCL成分的比例。根据DLBCL成分比例是否≥50%将患者分为两组。研究发现，DLBCL成分≥50%的患者较DLBCL成分<50%的患者具有更高的3级比例（94.3%对91.9%，P=0.010）、Ki-67指数≥70%比例（58.5%对32.9%，P=0.013）和PET-CT SUVmax≥13比例（72.4%对46.3%，P=0.030）。所有患者均接受CHOP或类似CHOP方案±利妥昔单抗化疗。总缓解率（ORR）为88.2%，完全缓解（CR）率为76.4%。在DLBCL成分比例不同的组中，诱导治疗后的缓解率及治疗开始后2年内疾病进展发生率（POD24）无显著差异（P>0.05）。总体估计5年无进展生存（PFS）率为58.9%，5年总生存（OS）率为90.4%。POD24患者的5年OS率低于非POD24患者（70.3%对98.5%，P<0.001）。与未进行利妥昔单抗维持治疗相比，利妥昔单抗维持治疗对5年PFS率无益处（57.7%对58.8%，P=0.543），对5年OS率有获益趋势，但差异无统计学意义（100%对87.8%，P=0.082）。多因素分析显示，诱导治疗后未达到CR是PFS的独立危险因素（P=0.006），而乳酸脱氢酶（LDH）高于正常是OS的独立危险因素（P=0.031）。伴有DLBCL成分≥50%的FL患者具有更具侵袭性的临床和病理特征。CHOP/类似CHOP方案±利妥昔单抗方案可提高患者的临床疗效。利妥昔单抗维持治疗对患者的PFS和OS无益处。诱导治疗后未达到CR是PFS的独立不利因素。
