Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Transplant Cell Ther. 2023 Nov;29(11):690-694. doi: 10.1016/j.jtct.2023.08.019. Epub 2023 Aug 20.
Primary mediastinal large B-cell lymphoma (PMBCL) is an uncommon, aggressive type of non-Hodgkin lymphoma. Rituximab-containing chemoimmunotherapy with or without radiation therapy (RT) is standard first-line treatment. Relapsed or refractory (R/R) disease has long been treated with salvage chemotherapy followed by high-dose chemotherapy (HDC), with autologous stem cell transplantation (ASCT) in appropriate patients. We retrospectively analyzed all patients with R/R PMBCL treated with HDC/ASCT at our center between January 2000 and August 2022. The 60 study patients received either rituximab-BEAM (n = 37) or rituximab-gemcitabine/busulfan/melphalan (R-GemBuMel) with or without vorinostat (n = 23), followed by ASCT. Forty-six patients received mediastinal RT, either as prior consolidation of frontline therapy or following ASCT. At median follow-up of 6 years (range, .3 to 21 years), the 5-year progression-free survival (PFS) and overall survival (OS) rates of the whole group were 58% and 77%, respectively, for the entire cohort, 51% and 65% for the R-BEAM recipients, and 69% and 82% for R-vorinostat/GemBuMel recipients. Multivariable analyses showed that a negative positron emission tomography scan at ASCT (hazard ratio [HR], .28) and involvement of only 1 organ (HR, .33) were independently associated with improved PFS. In addition, receipt of R-vorinostat/GemBuMel (HR, .23) was an independent favorable predictor of OS. Our data indicate that HDC/ASCT is effective in R/R PMBCL, with improved outcomes in patients receiving R-vorinostat/GemBuMel.
原发性纵隔大 B 细胞淋巴瘤（PMBCL）是一种罕见的侵袭性非霍奇金淋巴瘤。利妥昔单抗联合化疗加或不加放疗（RT）是标准的一线治疗。复发或难治性（R/R）疾病长期以来一直采用挽救性化疗，然后进行大剂量化疗（HDC），在合适的患者中进行自体干细胞移植（ASCT）。我们回顾性分析了 2000 年 1 月至 2022 年 8 月期间在我们中心接受 HDC/ASCT 治疗的所有 R/R PMBCL 患者。60 例研究患者接受了利妥昔单抗-BEAM（n=37）或利妥昔单抗-吉西他滨/硼替佐米/马法兰（R-GemBuMel）联合或不联合伏立诺他（n=23）治疗，随后进行 ASCT。46 例患者接受了纵隔 RT，或作为一线治疗的巩固治疗，或在 ASCT 后进行。中位随访 6 年（范围，.3 至 21 年），整个队列的 5 年无进展生存率（PFS）和总生存率（OS）分别为 58%和 77%，R-BEAM 组分别为 51%和 65%，R-vorinostat/GemBuMel 组分别为 69%和 82%。多变量分析显示，ASCT 时正电子发射断层扫描（PET）阴性（危险比[HR]，.28）和仅累及 1 个器官（HR，.33）与 PFS 改善独立相关。此外，接受 R-vorinostat/GemBuMel（HR，.23）是 OS 的独立有利预测因素。我们的数据表明，HDC/ASCT 对 R/R PMBCL 有效，接受 R-vorinostat/GemBuMel 治疗的患者预后改善。
