原发性纵隔大B细胞淋巴瘤中最佳给药的R-da-EPOCH方案与R-CHOP-21方案的比较：单一学术中心的真实世界对比
Optimally Delivered R-da-EPOCH Versus R-CHOP-21 in Primary Mediastinal Large B-Cell Lymphoma: A Real-Life Comparison in a Single Academic Center.
作者信息
Piperidou Alexia, Angelopoulou Maria K, Chatzidimitriou Chrysovalantou, Asimakopoulos John V, Arapaki Maria, Panitsas Fotios, Tsourouflis Gerassimos, Belia Marina, Konstantinou Iliana, Kopsaftopoulou Anastasia, Liaskas Athanasios, Machairas Alexandros, Lefaki Maria-Aikaterini, Dimitrakoudi Maria, Sachanas Sotirios, Pangalis Gerassimos A, Konstantopoulos Konstantinos, Plata Eleni, Siakantaris Marina, Vassilakopoulos Theodoros P
机构信息
Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece.
Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece.
出版信息
Cancers (Basel). 2025 May 19;17(10):1699. doi: 10.3390/cancers17101699.
BACKGROUND/OBJECTIVES: The National Cancer Institute introduced the intensified R-da-EPOCH regimen in primary mediastinal large B-cell lymphoma (PMLBCL) to improve outcomes while minimizing radiotherapy use. However, there is no randomized comparison of R-da-EPOCH vs. R-CHOP-21. The objective of this study was to compare R-da-EPOCH with R-CHOP-21 in consecutive patients with PMLBCL of a single, large referral center, where the R-da-EPOCH escalation schedule was strictly followed.
METHODS
We retrospectively analyzed all 35 consecutive patients who received R-da-EPOCH (2017-2022) compared to 35 consecutive patients treated with R-CHOP-21 arm at the same Department, starting from the most recent patient and going backwards (2005-2017).
RESULTS
R-da-EPOCH was given strictly in 33/35 (94%) patients. The 5-year freedom from progression (FFP) was 91% vs. 69% ( = 0.027). The 5-year event-free survival (EFS) was 84% vs. 69% ( = 0.124). The 5-year overall survival (OS) was 97% vs. 80% ( = 0.063). Among R-CHOP-21-responders, 20/29 (69%) received RT compared to 2/34 (6%) R-da-EPOCH-responders. In multivariate analysis, R-da-EPOCH remained better than R-CHOP-21 in terms of FFP [hazard ratios (HRs) 0.21-0.26, all < 0.05] and was associated with very favorable HR for EFS and OS.
CONCLUSIONS
Optimally delivered R-da-EPOCH minimized the use of RT in a real-life setting and provided superior outcomes than R-CHOP-21.
背景/目的：美国国立癌症研究所推出了强化R-da-EPOCH方案用于原发性纵隔大B细胞淋巴瘤（PMLBCL），以改善治疗效果并尽量减少放疗的使用。然而，R-da-EPOCH与R-CHOP-21之间尚无随机对照研究。本研究的目的是在一个大型单一转诊中心，对连续的PMLBCL患者比较R-da-EPOCH与R-CHOP-21，该中心严格遵循R-da-EPOCH递增方案。
方法
我们回顾性分析了所有连续接受R-da-EPOCH治疗的35例患者（2017 - 2022年），并与同一科室连续接受R-CHOP-21治疗的35例患者进行比较，从最近的患者开始倒推（2005 - 2017年）。
结果
33/35（94%）例患者严格接受了R-da-EPOCH治疗。5年无进展生存率（FFP）为91%，而R-CHOP-21组为69%（P = 0.027）。5年无事件生存率（EFS）为84%，而R-CHOP-21组为69%（P = 0.124）。5年总生存率（OS）为97%，而R-CHOP-21组为80%（P = 0.063）。在R-CHOP-21治疗有效的患者中，20/29（69%）接受了放疗，而R-da-EPOCH治疗有效的患者中这一比例为2/34（6%）。在多变量分析中，就FFP而言，R-da-EPOCH仍优于R-CHOP-21[风险比（HRs）为0.21 - 0.26，均P < 0.05]，并且与非常有利的EFS和OS的HR相关。
结论
在实际临床中，优化实施的R-da-EPOCH可尽量减少放疗的使用，且比R-CHOP-21能带来更好的治疗效果。
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