Weibull Caroline E, Wästerlid Tove, Wahlin Björn Engelbrekt, Andersson Per-Ola, Ekberg Sara, Lockmer Sandra, Enblad Gunilla, Crowther Michael J, Kimby Eva, Smedby Karin E
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.
Hemasphere. 2023 Feb 23;7(3):e838. doi: 10.1097/HS9.0000000000000838. eCollection 2023 Mar.
In follicular lymphoma (FL), progression of disease ≤24 months (POD24) has emerged as an important prognostic marker for overall survival (OS). We aimed to investigate survival more broadly by timing of progression and treatment in a national population-based setting. We identified 948 stage II-IV indolent FL patients in the Swedish Lymphoma Register diagnosed 2007-2014 who received first-line systemic therapy, followed through 2020. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by first POD at any time during follow-up using Cox regression. OS was predicted by POD using an illness-death model. During a median follow-up of 6.1 years (IQR: 3.5-8.4), 414 patients experienced POD (44%), of which 270 (65%) occurred ≤24 months. POD was represented by a transformation in 15% of cases. Compared to progression-free patients, POD increased all-cause mortality across treatments, but less so among patients treated with rituximab(R)-single (HR = 4.54, 95% CI: 2.76-7.47) than R-chemotherapy (HR = 8.17, 95% CI: 6.09-10.94). The effect of POD was similar following R-CHOP (HR = 8.97, 95% CI: 6.14-13.10) and BR (HR = 10.29, 95% CI: 5.60-18.91). The negative impact of POD on survival remained for progressions up to 5 years after R-chemotherapy, but was restricted to 2 years after R-single. After R-chemotherapy, the 5-year OS conditional on POD occurring at 12, 24, and 60 months was 34%, 46%, and 57% respectively, versus 78%, 82%, and 83% if progression-free. To conclude, POD before but also beyond 24 months is associated with worse survival, illustrating the need for individualized management for optimal care of FL patients.
在滤泡性淋巴瘤（FL）中，疾病进展≤24个月（POD24）已成为总生存期（OS）的一项重要预后标志物。我们旨在通过全国基于人群的研究，依据疾病进展时间和治疗情况更全面地探究生存情况。我们在瑞典淋巴瘤登记处中识别出948例2007 - 2014年诊断为II - IV期惰性FL且接受一线全身治疗的患者，并随访至2020年。使用Cox回归，通过随访期间任何时间的首次POD估计95%置信区间（CI）的风险比（HR）。使用疾病 - 死亡模型通过POD预测OS。在中位随访6.1年（IQR：3.5 - 8.4）期间，414例患者出现疾病进展（44%），其中270例（65%）发生在≤24个月时。15%的病例中疾病进展表现为转化。与无疾病进展的患者相比，疾病进展增加了所有治疗组的全因死亡率，但在接受利妥昔单抗（R）单药治疗的患者中（HR = 4.54，95% CI：2.76 - 7.47）比接受R - 化疗的患者中（HR = 8.17，95% CI：6.09 - 10.94）增加得少。在R - CHOP（HR = 8.97，95% CI：6.14 - 13.10）和BR（HR = 10.29，95% CI：5.60 - 18.91）治疗后，疾病进展的影响相似。疾病进展对生存的负面影响在R - 化疗后长达5年的进展中仍然存在，但在R单药治疗后仅限于2年。R - 化疗后，在第12、24和60个月发生疾病进展的情况下，5年总生存期分别为34%、46%和57%，而无疾病进展时分别为78%、82%和83%。总之，24个月之前及之后的疾病进展均与较差的生存相关，这表明需要个体化管理以实现FL患者的最佳治疗。
