Tom Baker Cancer Centre and University of Calgary, Calgary, Alberta, Canada.
Cross Cancer Institute and University of Alberta, Edmonton, Alberta, Canada.
Transplant Cell Ther. 2022 Nov;28(11):762.e1-762.e4. doi: 10.1016/j.jtct.2022.08.030. Epub 2022 Sep 1.
Double-hit lymphoma (DHL) is an aggressive large B cell lymphoma associated with a poor prognosis with R-CHOP chemotherapy. The optimal treatment is unknown, but outcomes might be improved with intensive induction regimens or consolidative high-dose chemotherapy and autologous stem cell transplantation (HDT/ASCT). The purpose of this study was to determine the real-world outcomes of patients with DHL treated with primarily R-CHOP induction and consolidative HDT/ASCT. This retrospective, multicenter study included consecutive patients age 18 to 70 years with newly diagnosed DHL intended for consolidative HDT/ASCT in Alberta, Canada. Progression-free survival (PFS) and overall survival (OS) were determined using the Kaplan-Meier method. The cohort comprised 58 patients with a median age of 59.5 years (range, 30 to 69 years). High-risk features at diagnosis included International Prognostic Index score 3 to 5 in 45 patients (78%), transformed indolent lymphoma in 25 (43%), and central nervous system involvement in 3 (5%). Forty-six patients (79%) patients received R-CHOP induction, and 45 (78%) proceeded to consolidative HDT/ASCT. With a median follow-up of 4.6 years, the 4-year PFS and OS rates were 67% (95% confidence interval [CI], 53% to 78%) and 68% (95% CI, 54% to 79%), respectively, for all patients and 86% (95% CI, 72% to 93%) and 88% (95% CI, 73% to 95%) for those undergoing HDT/ASCT. R-CHOP induction and consolidative HDT/ASCT result in excellent outcomes for patients with chemosensitive DHL, whereas patients with primary refractory disease might benefit from alternative strategies, such as earlier use of chimeric antigen receptor T cell therapy.
双打击淋巴瘤（DHL）是一种侵袭性大 B 细胞淋巴瘤，与 R-CHOP 化疗相关，预后不良。最佳治疗方法尚不清楚，但强化诱导方案或巩固性大剂量化疗和自体造血干细胞移植（HDT/ASCT）可能改善预后。本研究旨在确定主要接受 R-CHOP 诱导和巩固性 HDT/ASCT 治疗的 DHL 患者的真实世界结局。这是一项回顾性、多中心研究，纳入了加拿大艾伯塔省年龄在 18 至 70 岁之间、新诊断为 DHL 且计划接受巩固性 HDT/ASCT 的连续患者。采用 Kaplan-Meier 法确定无进展生存（PFS）和总生存（OS）。该队列包括 58 例患者，中位年龄 59.5 岁（范围 30 至 69 岁）。诊断时的高危特征包括 45 例（78%）患者国际预后指数评分 3-5 分、25 例（43%）转化惰性淋巴瘤和 3 例（5%）中枢神经系统受累。46 例（79%）患者接受 R-CHOP 诱导，45 例（78%）患者接受巩固性 HDT/ASCT。中位随访 4.6 年后，所有患者的 4 年 PFS 和 OS 率分别为 67%（95%CI，53%至 78%）和 68%（95%CI，54%至 79%），接受 HDT/ASCT 的患者分别为 86%（95%CI，72%至 93%）和 88%（95%CI，73%至 95%）。对于化疗敏感的 DHL 患者，R-CHOP 诱导和巩固性 HDT/ASCT 可获得良好的结局，而对于原发性耐药疾病患者，可能受益于替代策略，如更早使用嵌合抗原受体 T 细胞治疗。
