Jiang Linmiao, Dreyling Martin, Hermine Olivier, Mansmann Ulrich, Walewski Jan, Ribrag Vincent, Thieblemont Catherine, Pott Christiane, Bachy Emmanuel, Feugier Pierre, Hübel Kai, Schumacher Martin, Hoster Eva
Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany.
Department of Internal Medicine III, LMU University Hospital Munich, Munich, Germany.
Br J Haematol. 2025 Jan;206(1):159-166. doi: 10.1111/bjh.19854. Epub 2024 Oct 23.
During a fatal disease, patients often request updated information on their prognosis. After patients have already survived a certain time, conditional survival captures their future survival probability. We investigated conditional overall and failure-free survival in 473 younger mantle cell lymphoma (MCL) patients from a randomized phase III trial comparing immunochemotherapies R-CHOP and alternating R-CHOP/R-DHAP before autologous transplantation. Using conditional Kaplan-Meier method and Cox regression, we estimated subsequent survival of patients who had survived 1-8 years, considering MIPI, Ki-67, and treatment failure status. Starting at a lower level, R-CHOP patients only showed increasing subsequent survival as they survived longer (5-year conditional survival: 72% and 81% after surviving 1 and 7 years), while R-CHOP/R-DHAP patients had stable future survival over time (77% and 78%). The prognostic value of MIPI diminished after 3 years in R-CHOP patients but remained unchanged after R-CHOP/R-DHAP. Patients with treatment failure had markedly inferior survival compared with those in ongoing remission, regardless of the time survived. The longer patients remained in remission, the longer they would stay free of treatment failures. Our results enable personalized counselling for younger MCL patients by offering dynamic prognosis and underscore the importance of highly effective first-line treatment to improve survival.
在患有致命疾病期间，患者常常要求获取有关其预后的最新信息。在患者已经存活一定时间后，条件生存反映了他们未来的生存概率。我们对473例年轻的套细胞淋巴瘤（MCL）患者进行了条件总生存和无失败生存的研究，这些患者来自一项随机III期试验，该试验比较了自体移植前免疫化疗R-CHOP和交替使用R-CHOP/R-DHAP的疗效。我们使用条件Kaplan-Meier方法和Cox回归分析，评估了存活1至8年患者的后续生存情况，同时考虑了国际预后指数（MIPI）、Ki-67和治疗失败状态。从较低水平开始，R-CHOP方案治疗的患者随着存活时间延长，后续生存率仅呈上升趋势（存活1年和7年后的5年条件生存率分别为72%和81%），而接受R-CHOP/R-DHAP方案治疗的患者未来生存率随时间保持稳定（分别为77%和78%）。在R-CHOP方案治疗的患者中，MIPI的预后价值在3年后降低，但在接受R-CHOP/R-DHAP方案治疗的患者中保持不变。无论存活时间长短，治疗失败的患者生存率明显低于仍处于持续缓解期的患者。患者缓解期越长，无治疗失败的时间就越长。我们的研究结果通过提供动态预后情况，为年轻MCL患者实现个性化咨询提供了依据，并强调了高效一线治疗对提高生存率的重要性。
