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在部分缓解的复发/难治性弥漫性大 B 细胞淋巴瘤患者中,自体造血干细胞移植前进行额外化疗的作用——一项回顾性多中心研究。

The role of additional chemotherapy prior to autologous HCT in patients with relapse/refractory DLBCL in partial remission-A retrospective multicenter study.

机构信息

Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva, Israel.

Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

出版信息

Eur J Haematol. 2023 Feb;110(2):149-156. doi: 10.1111/ejh.13884. Epub 2022 Oct 25.


DOI:10.1111/ejh.13884
PMID:36251268
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10092282/
Abstract

OBJECTIVES: To evaluate the role of additional chemotherapy before autologous hematopoietic cell transplantation (HCT) in patients with relapse/refractory diffuse large B-cell lymphoma (DLBCL) who achieve partial remission following first salvage therapy. METHODS: We conducted a multicenter retrospective study of all adult patients with DLBCL who underwent HCT between 2008 and 2020 and achieved partial response (PR) after the first salvage and were either referred directly to HCT (n = 47) or received additional salvage therapy before HCT (n = 22). RESULTS: Post-HCT CR rate and progression-free survival were comparable between the two groups (66% vs. 68%, p = .86 and median not reached vs. 10.2 months [95% confidence interval, CI 7.1-12.3], p = .27, respectively). Median overall survival (OS) and estimated 3-year OS favored patients who were directly referred to HCT (105.8 [95% CI 63-148] months vs. 14.5 [95% CI 0-44] months, p = .035, and 65% [95% CI 51%-75%] vs. 40% [95% CI 21%-53%], p = .035, respectively). In Cox regression model, while International Prognostic Index and primary refractory versus relapse disease did not impact OS, allocation to a second salvage regimen and older age were both associated with inferior survival (hazard ratio [HR] = 2.57 95% CI 1.1-5.8, p = .023 and HR = 1.04 95% CI 0.99-1.2, p = .064, respectively). CONCLUSIONS: Referring patients with chemotherapy-sensitive disease in PR directly to HCT is associated with better OS compared to those receiving additional lines of treatment.

摘要

目的:评估在首次挽救性治疗后达到部分缓解(PR)的复发/难治性弥漫性大 B 细胞淋巴瘤(DLBCL)患者,在接受自体造血细胞移植(HCT)前接受额外化疗的作用。

方法:我们对 2008 年至 2020 年间接受 HCT 且在首次挽救治疗后达到 PR 且直接接受 HCT(n=47)或在 HCT 前接受额外挽救性治疗(n=22)的所有成年 DLBCL 患者进行了多中心回顾性研究。

结果:两组患者 HCT 后的完全缓解(CR)率和无进展生存期(PFS)无差异(66% vs. 68%,p=0.86 和未达到 vs. 10.2 个月[95%CI 7.1-12.3],p=0.27)。中位总生存期(OS)和估计的 3 年 OS 有利于直接接受 HCT 的患者(105.8 [95%CI 63-148] 个月 vs. 14.5 [95%CI 0-44] 个月,p=0.035 和 65% [95%CI 51%-75%] vs. 40% [95%CI 21%-53%],p=0.035)。在 Cox 回归模型中,国际预后指数和初治时是否为难治性疾病对 OS 无影响,而接受二线挽救方案和年龄较大均与较差的生存相关(危险比[HR]分别为 2.57[95%CI 1.1-5.8],p=0.023 和 1.04[95%CI 0.99-1.2],p=0.064)。

结论:与接受额外治疗的患者相比,将化疗敏感疾病的患者直接接受 HCT 与更好的 OS 相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e9a4/10092282/dedf4dfa0bbf/EJH-110-149-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e9a4/10092282/1ecd492cb867/EJH-110-149-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e9a4/10092282/806de810ff96/EJH-110-149-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e9a4/10092282/dedf4dfa0bbf/EJH-110-149-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e9a4/10092282/1ecd492cb867/EJH-110-149-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e9a4/10092282/806de810ff96/EJH-110-149-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e9a4/10092282/dedf4dfa0bbf/EJH-110-149-g003.jpg

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引用本文的文献

[1]
Autologous Transplantation May Still Effectively Treat Relapsed Diffuse Large B-Cell Lymphoma in Selected Patients.

Cancers (Basel). 2023-6-16

本文引用的文献

[1]
Positron emission tomography derived metrics in relapsed or refractory large B-cell lymphoma with residual disease before autologous stem cell transplant.

Br J Haematol. 2023-1

[2]
Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma.

N Engl J Med. 2022-2-17

[3]
CAR-T cell therapy in India requires a paradigm shift in training, education and health care processes.

Cytotherapy. 2022-2

[4]
Autologous transplant vs chimeric antigen receptor T-cell therapy for relapsed DLBCL in partial remission.

Blood. 2022-3-3

[5]
Cost effectiveness of axicabtagene ciloleucel versus tisagenlecleucel for adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy in the United States.

J Med Econ. 2021

[6]
Is autologous transplant in relapsed DLBCL patients achieving only a PET+ PR appropriate in the CAR T-cell era?

Blood. 2021-3-11

[7]
Cost Effectiveness of Chimeric Antigen Receptor T-Cell Therapy in Multiply Relapsed or Refractory Adult Large B-Cell Lymphoma.

J Clin Oncol. 2019-6-3

[8]
Long-term Survival and Cost-effectiveness Associated With Axicabtagene Ciloleucel vs Chemotherapy for Treatment of B-Cell Lymphoma.

JAMA Netw Open. 2019-2-1

[9]
Long-term safety and activity of axicabtagene ciloleucel in refractory large B-cell lymphoma (ZUMA-1): a single-arm, multicentre, phase 1-2 trial.

Lancet Oncol. 2018-12-2

[10]
Outcome of patients with relapsed diffuse large B-cell lymphoma who fail second-line salvage regimens in the International CORAL study.

Bone Marrow Transplant. 2016-1

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