Ng Lawrence Cheng Kiat, Ong Shin Yeu, Huang Xinxin, Ghosh Aditi, Nagarajan Chandramouli, Goh Yeow Tee, Chen Yunxin, Lim Francesca Lorraine Wei Inng, Tan Melinda Si Yun, Lee Xiu Hue, Tan Jing Yuan, Grigoropoulos Nicholas Francis, Yang Valerie Shiwen, Hoe Joshua Tian Ming, Chiang Jianbang, Chang Esther Wei Yin, Poon Eileen Yi Ling, Tan Ya Hwee, Somasundaram Nagavalli, Tao Miriam, Lim Soon Thye, Chan Jason Yongsheng
Department of Hematology, Singapore General Hospital, Singapore, Singapore.
Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Leuk Lymphoma. 2025 May;66(5):906-912. doi: 10.1080/10428194.2024.2446615. Epub 2024 Dec 28.
The importance of extra-nodal disease has been well recognized in follicular lymphoma, and is incorporated into various prognostic tools. However, the optimal treatment strategy for this subgroup remains unclear. In this multicenter retrospective study, we analyzed 143 patients who received either R-CHOP or Bendamustine-Rituximab (BR), with a median follow-up of 69.7 months. Our findings indicate that extra-nodal disease confers poorer PFS (5-year PFS 58% vs 66%, = 0.03) while high-risk relapse predict poorer OS (5-year OS 56% vs 94%, < 0.001). Subgroup analysis on 98 patients with extra-nodal disease revealed that BR induction conferred superior PFS compared to R-CHOP (HR 0.49, = 0.032) while maintenance rituximab also improved PFS (HR 0.44, = 0.033). Patients who received R-CHOP without maintenance rituximab had significantly worse PFS (5-year PFS 41% vs 68%, = 0.005) and OS (5-year OS 83% vs 100%, = 0.007) compared to those with maintenance rituximab. Role of maintenance rituximab post BR remained unclear. In this retrospective study of follicular lymphoma patients with extra-nodal disease, BR induction yielded favorable PFS compared to R-CHOP and could be a preferred treatment approach. Maintenance rituximab after R-CHOP significantly improve PFS and OS and should be considered in all appropriate patients.
结外病变在滤泡性淋巴瘤中的重要性已得到充分认识，并被纳入各种预后评估工具中。然而，该亚组的最佳治疗策略仍不明确。在这项多中心回顾性研究中，我们分析了143例接受R-CHOP或苯达莫司汀-利妥昔单抗（BR）治疗的患者，中位随访时间为69.7个月。我们的研究结果表明，结外病变的无进展生存期较差（5年无进展生存率58%对66%，P = 0.03），而高危复发预示总生存期较差（5年总生存率56%对94%，P < 0.001）。对98例有结外病变的患者进行亚组分析显示，与R-CHOP相比，BR诱导治疗的无进展生存期更优（风险比0.49，P = 0.032），同时维持使用利妥昔单抗也改善了无进展生存期（风险比0.44，P = 0.033）。与接受R-CHOP且维持使用利妥昔单抗的患者相比，未接受维持利妥昔单抗治疗的患者无进展生存期显著更差（5年无进展生存率41%对68%，P = 0.005），总生存期也更差（5年总生存率83%对100%，P = 0.007）。BR治疗后维持使用利妥昔单抗的作用仍不明确。在这项针对有结外病变的滤泡性淋巴瘤患者的回顾性研究中，与R-CHOP相比，BR诱导治疗的无进展生存期更佳，可能是一种首选的治疗方法。R-CHOP治疗后维持使用利妥昔单抗可显著改善无进展生存期和总生存期，所有合适的患者均应考虑使用。
