南非资源有限环境下用 R-CHOP 治疗弥漫性大 B 细胞淋巴瘤的真实世界研究。

Diffuse Large B-Cell Lymphoma Treated With R-CHOP in a Resource-Limited Setting in South Africa: A Real-World Study.

机构信息

Radiation Oncology Department, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, Republic of South Africa.

Massachusetts General Hospital Cancer Center and the POETIC Fellowship Exchange Program, Dana Faber, Harvard Cancer Center, Boston, MA, USA.

出版信息

Oncologist. 2023 Sep 7;28(9):e756-e764. doi: 10.1093/oncolo/oyad069.

BACKGROUND

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma worldwide and particularly in Africa, where the incidence of HIV is the highest in the world. R-CHOP is the standard of care regimen for DLBCL, but access to rituximab is limited in developing countries.

METHODS

This is a retrospective cohort study that included all HIV-negative patients with DLBCL who received R-CHOP at a single institution from January 2012 to December 2017. Clinical and demographic data were collected to assess factors that influenced survival.

RESULTS

Seventy-three patients were included. Median age was 55 (17-76), 67.1% of patients were younger than 60 years, and 60.3% were female. Most presented with stages III/IV disease (53.5%) but with good performance status (56.% PS 0 and 1). Progression-free survival at 3 and 5 years was 75% and 69%, and overall survival at 3 and 5 years was 77% and 74%, respectively. Median survival had not been reached with a median follow-up of 3.5 years(0.13-7.9). Overall survival was significantly affected by performance status (P = .04), but not by IPI or age. Survival was significantly associated with response to chemotherapy after 4-5 cycles of R-CHOP (P = 0.005).

CONCLUSIONS

Treatment of DLBCL with R-CHOP is feasible and can achieve good outcomes in resource-limited settings with rituximab-based chemotherapy. Poor performance status was the most important adverse prognostic factor in this cohort of HIV-negative patients.

背景

弥漫性大 B 细胞淋巴瘤（DLBCL）是全球最常见的非霍奇金淋巴瘤亚型，尤其是在艾滋病发病率全球最高的非洲。R-CHOP 是 DLBCL 的标准治疗方案，但在发展中国家，利妥昔单抗的可及性有限。

方法

这是一项回顾性队列研究，纳入了 2012 年 1 月至 2017 年 12 月期间在一家机构接受 R-CHOP 治疗的所有 HIV 阴性 DLBCL 患者。收集临床和人口统计学数据，以评估影响生存的因素。

结果

共纳入 73 例患者。中位年龄为 55 岁（17-76 岁），67.1%的患者年龄小于 60 岁，60.3%为女性。大多数患者为 III/IV 期疾病（53.5%），但表现状态良好（56.% PS 0 和 1）。3 年和 5 年无进展生存率分别为 75%和 69%，3 年和 5 年总生存率分别为 77%和 74%。中位随访时间为 3.5 年（0.13-7.9），中位生存时间尚未达到。总生存率显著受表现状态（P=0.04）影响，但不受国际预后指数（IPI）或年龄影响。化疗 4-5 个周期后对 R-CHOP 的反应与生存显著相关（P=0.005）。