Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany.
Ann Hematol. 2023 Oct;102(10):2791-2801. doi: 10.1007/s00277-023-05385-1. Epub 2023 Aug 8.
Mantle cell lymphoma (MCL) is a distinct subtype of B-cell lymphoma and commonly used induction immunochemotherapies include the anti-CD20 antibody rituximab. However, efficacy data for rituximab regarding overall survival (OS) in first line MCL therapy remain conflicting.We report long-term outcomes of a pooled trials analysis comparing Cyclophosphamide, Doxorubicine, Vincristine, Prednisone (CHOP) to R-CHOP in MCL to confirm efficacy on failure free survival (FFS) and OS in relevant subgroups. Untreated, adult MCL patients of two prospective trials assigned to CHOP or R-CHOP were included. Primary endpoints were FFS and OS, secondary endpoints included duration of response (DOR), secondary malignancies and OS after relapse. Between 1996 and 2003, 385 MCL patients were assigned to CHOP (201) or R-CHOP (184). After a median follow-up of 13.4 years, the addition of Rituximab significantly improved FFS (1.36 vs. 2.07 years, HR 0.62 (0.50-0.77)), OS (4.84 vs. 5.81 years, HR 0.78 (0.61-0.99)) and DOR (1.48 vs. 2.08 years, HR 0.67 (0.53-0.86)). Furthermore, Rituximab improved survival across different MCL risk groups. In a post-hoc analysis of OS after relapse comparing patients receiving chemotherapy with / without rituximab, rituximab maintained efficacy with a median OS of 3.10 vs. 2.11 years (HR 0.70, 0.54-0.91). The rate of secondary malignancies was 0.5 and 3.9% for hematological and 7 and 8% for non-hematological malignancies for CHOP and R-CHOP patients, respectively. We present mature results of a pooled MCL cohort, demonstrating prolonged FFS, OS and DOR for the combined immuno-chemotherapy, confirming the standard of care in first line treatment.
套细胞淋巴瘤（MCL）是 B 细胞淋巴瘤的一种独特亚型，常用的诱导免疫化疗包括抗 CD20 抗体利妥昔单抗。然而，关于利妥昔单抗在一线 MCL 治疗中的总生存（OS）疗效数据仍存在争议。我们报告了一项汇总分析的长期结果，该分析比较了环磷酰胺、多柔比星、长春新碱、泼尼松（CHOP）与 R-CHOP 在 MCL 中的疗效，以确认在相关亚组中的无失败生存（FFS）和 OS 方面的疗效。纳入了两项前瞻性试验中未经治疗的成年 MCL 患者，这些患者被分配到 CHOP 或 R-CHOP 治疗组。主要终点是 FFS 和 OS，次要终点包括缓解持续时间（DOR）、继发恶性肿瘤和复发后的 OS。1996 年至 2003 年间，385 例 MCL 患者被分配到 CHOP（201 例）或 R-CHOP（184 例）治疗组。中位随访 13.4 年后，添加利妥昔单抗显著改善了 FFS（1.36 年 vs. 2.07 年，HR 0.62（0.50-0.77））、OS（4.84 年 vs. 5.81 年，HR 0.78（0.61-0.99））和 DOR（1.48 年 vs. 2.08 年，HR 0.67（0.53-0.86））。此外，利妥昔单抗改善了不同 MCL 风险组的生存。在比较接受化疗加/不加利妥昔单抗的复发后 OS 的事后分析中，利妥昔单抗保持了疗效，中位 OS 为 3.10 年 vs. 2.11 年（HR 0.70，0.54-0.91）。CHOP 和 R-CHOP 患者的继发性恶性肿瘤发生率分别为 0.5%和 3.9%（血液系统）和 7%和 8%（非血液系统）。我们呈现了一个汇总的 MCL 队列的成熟结果，证明了联合免疫化疗的延长 FFS、OS 和 DOR，证实了一线治疗中的标准治疗方法。
