利妥昔单抗对血管免疫母细胞性 T 细胞淋巴瘤患者治疗结局的影响：一项基于人群的分析。

Impact of rituximab on treatment outcomes of patients with angioimmunoblastic T-cell lymphoma; a population-based analysis.

机构信息

Department of Hematology, Treant Hospital, Emmen, the Netherlands; Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands.

Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.

出版信息

Eur J Cancer. 2022 Nov;176:100-109. doi: 10.1016/j.ejca.2022.09.008. Epub 2022 Oct 5.

DOI:10.1016/j.ejca.2022.09.008

PMID:36208568

Abstract

BACKGROUND

Patients with angioimmunoblastic T-cell lymphoma (AITL) are treated with cyclophosphamide, doxorubicin, vincristine and prednisone with or without etoposide (CHO(E)P). In the majority of cases, Epstein-Barr virus (EBV)-positive B-cells are present in the tumour. There is paucity of research examining the effect of rituximab when added to CHO(E)P. In this nationwide, population-based study, we analysed the impact of rituximab on overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) of patients with AITL.

METHODS

Patients with AITL diagnosed between 2014 and 2020 treated with ≥one cycle of CHO(E)P with or without rituximab were identified in the Netherlands Cancer Registry. Survival follow-up was up to 1st February 2022. Baseline characteristics, best response during first-line treatment and survival were collected. PFS was defined as the time from diagnosis to relapse or to all-cause-death. OS was defined as the time from diagnosis to all-cause-death. Multivariable analysis for the risk of mortality was performed using Cox regression.

FINDINGS

Out of 335 patients, 146 patients (44%) received R-CHO(E)P. Rituximab was more frequently used in patients with a B-cell infiltrate (71% versus 89%, p < 0·01). The proportion of patients who received autologous stem cell transplantation (ASCT) was similar between CHO(E)P and R-CHO(E)P (27% versus 30%, respectively). The ORR and 2-year PFS for patients who received CHO(E)P and R-CHO(E)P were 71% and 78% (p = 0·01), and 40% and 45% (p = 0·12), respectively. The 5-year OS was 47% and 40% (p = 0·99), respectively. In multivariable analysis, IPI-score 3-5, no B-cell infiltrate and no ASCT were independent prognostic factors for risk of mortality, whereas the use of rituximab was not.

INTERPRETATION

Although the addition of rituximab to CHO(E)P improved ORR for patients with AITL, the PFS and OS did not improve.

摘要

背景

血管免疫母细胞性 T 细胞淋巴瘤（AITL）患者接受环磷酰胺、多柔比星、长春新碱和泼尼松联合或不联合依托泊苷（CHO(E)P）治疗。在大多数情况下，肿瘤中存在 EBV 阳性 B 细胞。目前，关于利妥昔单抗联合 CHO(E)P 治疗的效果研究较少。在这项全国性、基于人群的研究中，我们分析了利妥昔单抗对 AITL 患者总体缓解率（ORR）、无进展生存期（PFS）和总生存期（OS）的影响。

方法

在荷兰癌症登记处确定了 2014 年至 2020 年间接受至少一个周期 CHO(E)P 联合或不联合利妥昔单抗治疗的 AITL 患者。生存随访截止至 2022 年 2 月 1 日。收集基线特征、一线治疗期间的最佳反应和生存情况。PFS 定义为从诊断到复发或全因死亡的时间。OS 定义为从诊断到全因死亡的时间。使用 Cox 回归进行多变量分析，以评估死亡风险。

结果

在 335 名患者中，146 名患者（44%）接受了 R-CHO(E)P 治疗。利妥昔单抗更常用于有 B 细胞浸润的患者（71%比 89%，p<0.01）。接受自体造血干细胞移植（ASCT）的患者比例在 CHO(E)P 和 R-CHO(E)P 组之间相似（分别为 27%和 30%）。接受 CHO(E)P 和 R-CHO(E)P 治疗的患者的 ORR 和 2 年 PFS 分别为 71%和 78%（p=0.01）和 40%和 45%（p=0.12）。5 年 OS 分别为 47%和 40%（p=0.99）。多变量分析显示，国际预后指数（IPI）评分 3-5、无 B 细胞浸润和无 ASCT 是死亡风险的独立预后因素，而利妥昔单抗的使用则不是。