匹配对照分析表明,与 R-CHOP 相比,R-CHOP 后序贯(R)-ICE 可能改善非生发中心 B 细胞型弥漫大 B 细胞淋巴瘤的预后。

Matched control analysis suggests that R-CHOP followed by (R)-ICE may improve outcome in non-GCB DLBCL compared with R-CHOP.

机构信息

Department of Medicine, Division of Hematologic Malignancies, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY.

Department of Quantitative Sciences, Mayo Clinic, Rochester, MN.

出版信息

Blood Adv. 2024 May 14;8(9):2172-2181. doi: 10.1182/bloodadvances.2023011408.

Abstract

Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is considered the standard-of-care for patients with advanced-stage diffuse large B-cell lymphoma (DLBCL), despite findings that patients with nongerminal center B-cell like (non-GCB) have significantly worse outcome with this regimen. We evaluated the prognostic significance of baseline risk factors, including cell of origin (COO) classified by the Hans algorithm, within an alternative chemoimmunotherapy program. At Memorial Sloan Kettering Cancer Center (MSK), 151 patients with DLBCL received sequential R-CHOP induction and (R)-ICE (rituximab, ifosfamide, carboplatin, and etoposide) consolidation. Outcome analysis based on COO was validated with a propensity score-matched cohort treated with R-CHOP from the Mayo Clinic component of the Molecular Epidemiology Resource (MER). Among the patients with GCB (n = 69) and non-GCB (n = 69) at MSK, event-free survival (EFS) of non-GCB was superior to that of GCB (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.29-0.98). Overall survival (OS) demonstrated an association in the same direction but was not statistically significant (HR, 0.68; 95% CI, 0.33-1.42). Propensity score-matched patients from MSK (n = 108) demonstrated a small attenuation in the HRs for EFS (HR, 0.57; 95% CI, 0.27-1.18) and OS (HR, 0.76; 95% CI, 0.33-1.79) and were no longer statistically significant. In contrast, the matched MER cohort (n = 108) demonstrated an EFS association (HR, 1.17; 95% CI, 0.70-1.95) and OS association (HR, 1.13; 95% CI, 0.64-2.00) in the opposite direction, but were also not statistically significant. R-CHOP induction and (R)-ICE consolidation may overcome the negative prognostic impact of the non-GCB phenotype, per the Hans algorithm, and can be preferentially selected for this population. This trial was registered at www.ClinicalTrials.gov as #NCT00039195 and #NCT00712582.

摘要

利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松(R-CHOP)被认为是晚期弥漫性大 B 细胞淋巴瘤(DLBCL)患者的标准治疗方法,尽管研究发现非生发中心 B 细胞样(non-GCB)患者使用该方案的预后明显更差。我们评估了基线风险因素的预后意义,包括通过 Hans 算法分类的细胞起源(COO),该风险因素存在于替代的化疗免疫治疗方案中。在纪念斯隆凯特琳癌症中心(MSK),151 例 DLBCL 患者接受了 R-CHOP 诱导和(R)-ICE(利妥昔单抗、异环磷酰胺、卡铂和依托泊苷)巩固治疗。基于 COO 的结果分析通过与接受 R-CHOP 治疗的 Mayo 诊所分子流行病学资源(MER)部分的患者进行倾向评分匹配队列进行了验证。在 MSK 的 GCB(n=69)和 non-GCB(n=69)患者中,non-GCB 的无事件生存(EFS)优于 GCB(风险比[HR],0.53;95%置信区间[CI],0.29-0.98)。总生存(OS)显示出相同方向的关联,但没有统计学意义(HR,0.68;95%CI,0.33-1.42)。来自 MSK 的倾向评分匹配患者(n=108)的 EFS(HR,0.57;95%CI,0.27-1.18)和 OS(HR,0.76;95%CI,0.33-1.79)的 HR 略有减弱,且不再具有统计学意义。相比之下,匹配的 MER 队列(n=108)显示出相反方向的 EFS 关联(HR,1.17;95%CI,0.70-1.95)和 OS 关联(HR,1.13;95%CI,0.64-2.00),但也没有统计学意义。根据 Hans 算法,R-CHOP 诱导和(R)-ICE 巩固可能克服非 GCB 表型的负性预后影响,并可优先用于该人群。这项试验在 www.ClinicalTrials.gov 上注册为 #NCT00039195 和 #NCT00712582。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa78/11068505/c54531e9661c/BLOODA_ADV-2023-011408-ga1.jpg

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