Lee A Y, Connors J M, Klimo P, O'Reilly S E, Gascoyne R D
Department of Medicine, British Columbia Cancer Agency, Vancouver Clinic, Canada.
J Clin Oncol. 1997 May;15(5):1745-53. doi: 10.1200/JCO.1997.15.5.1745.
To examine the clinical course of patients who experienced a late relapse after initial curative chemotherapy for advanced-stage diffuse large-cell lymphoma.
Between April 1981 and June 1986, 127 patients with de novo advanced-stage diffuse large-cell lymphoma were treated with a 12-week chemotherapy program (methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin [MACOP-B]). The overall survival rate at 10 years is 52%. One hundred six patients (83%) entered a complete remission (CR) and 43 of them relapsed. With a median follow-up duration of 146 months, 26 patients relapsed early and 17 relapsed late, ie, after a continuous CR (cCR) of greater than 24 months. All late relapses occurred in patients with B-cell lymphoma.
After 24 months from diagnosis, the rate of late relapse averaged 2.2% per year and reached a projected 22% actuarial risk of late relapse after 10 years. The median time to late relapse was 69 months (range, 38 to 141). Ten patients relapsed with aggressive histologic subtypes and were treated with curative intent using anthracycline-based chemotherapy. Four remain in second CR, one is alive with disease, and five died of disease or while on treatment. The 6-year overall survival rate from the time of relapse (SFR) for these 10 patients is 42%. Six patients relapsed with low-grade follicular lymphoma. These patients received various treatments intended to control, but not necessarily cure disease. One is in second CR, one is alive with disease, and four died of disease or while on treatment. The 6-year overall SFR rate for these six patients is 40%. bcl-2 translocation and Bcl-2 protein expression at diagnosis did not predict for the type of late relapse. One patient did not undergo repeat biopsy at relapse and died 9 months later despite aggressive therapy.
Curative therapy should be attempted in patients who relapse late with aggressive-histology lymphoma and those who relapse with follicular histology may benefit from palliative treatment. The behavior of late-relapse lymphoma is similar to de novo lymphoma, with outcome dictated by the histologic subtype at relapse.
研究晚期弥漫大细胞淋巴瘤初始根治性化疗后出现晚期复发患者的临床病程。
1981年4月至1986年6月期间，127例初发晚期弥漫大细胞淋巴瘤患者接受了为期12周的化疗方案（甲氨蝶呤、阿霉素、环磷酰胺、长春新碱、泼尼松和博来霉素[MACOP - B]）。10年总生存率为52%。106例患者（83%）达到完全缓解（CR），其中43例复发。中位随访时间为146个月，26例患者早期复发，17例患者晚期复发，即持续完全缓解（cCR）超过24个月后复发。所有晚期复发均发生在B细胞淋巴瘤患者中。
诊断后24个月，晚期复发率平均每年2.2%，10年后预计晚期复发累积风险达22%。晚期复发的中位时间为69个月（范围38至141个月）。10例侵袭性组织学亚型复发患者接受了以蒽环类为基础的根治性化疗。4例仍处于第二次CR状态，1例带瘤生存，5例死于疾病或治疗期间。这10例患者复发后6年总生存率（SFR）为42%。6例低级别滤泡性淋巴瘤复发患者。这些患者接受了旨在控制而非根治疾病的各种治疗。1例处于第二次CR状态，1例带瘤生存，4例死于疾病或治疗期间。这6例患者的6年总SFR率为40%。诊断时bcl - 2易位和Bcl - 2蛋白表达不能预测晚期复发类型。1例复发时未进行重复活检，尽管积极治疗，但9个月后死亡。
侵袭性组织学淋巴瘤晚期复发患者应尝试进行根治性治疗，滤泡性组织学复发患者可能从姑息治疗中获益。晚期复发淋巴瘤的行为与初发淋巴瘤相似，其结局取决于复发时的组织学亚型。
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