Popat U, Przepiork D, Champlin R, Pugh W, Amin K, Mehra R, Rodriguez J, Giralt S, Romaguera J, Rodriguez A, Preti A, Andersson B, Khouri I, Claxton D, de Lima M, Donato M, Anderlini P, Gajewski J, Cabanillas F, van Besien K
Department of Hematology, MD Anderson Cancer Center, Houston, TX, USA.
J Clin Oncol. 1998 Jan;16(1):63-9. doi: 10.1200/JCO.1998.16.1.63.
This study was performed to evaluate the outcome of high-dose chemotherapy and autologous transplantation in patients with diffuse B-cell large-cell lymphoma, and, specifically, to evaluate the impact of primary mediastinal localization on the outcome of high-dose chemotherapy.
A retrospective review was performed of all patients with diffuse large B-cell lymphoma who underwent autologous marrow or peripheral-blood stem-cell transplantation at our institution between January 1 986 and December 1995.
Ninety patients were identified, of whom 31 (34%) had a primary mediastinal B-cell large-cell lymphoma (PML). Cumulative probabilities of disease-free survival, overall survival, and disease progression are 40% (95% confidence interval [CI], 29 to 51), 42% (95% CI, 31 to 53), and 52% (95% CI, 40 to 64), respectively. By univariate analysis, low lactate dehydrogenase (LDH) level and low Ann Arbor stage at transplant were associated with improved survival and disease-free survival. There was a trend for improved disease-free survival and survival for patients with PML. Multivariate stepwise Cox regression analysis showed that LDH level, Ann Arbor stage, and primary mediastinal localization were independent favorable prognostic factors for disease-free survival and survival. LDH level and Ann Arbor stage were also predictive for the risk of disease progression.
Our results indicate that patients with PML may display an increased susceptibility to high-dose chemotherapy compared with other types of B-cell large-cell lymphoma. These findings, if confirmed, may have implications for the initial management of patients with PML.
本研究旨在评估大剂量化疗及自体移植治疗弥漫性B细胞大细胞淋巴瘤患者的疗效，具体而言，是评估原发纵隔定位对大剂量化疗疗效的影响。
对1986年1月1日至1995年12月期间在本机构接受自体骨髓或外周血干细胞移植的所有弥漫性大B细胞淋巴瘤患者进行回顾性分析。
共纳入90例患者，其中31例（34%）为原发性纵隔B细胞大细胞淋巴瘤（PML）。无病生存率、总生存率和疾病进展的累积概率分别为40%（95%置信区间[CI]，29%至51%）、42%（95%CI，31%至53%）和52%（95%CI，40%至64%）。单因素分析显示，低乳酸脱氢酶（LDH）水平和移植时低Ann Arbor分期与生存率和无病生存率的提高相关。PML患者的无病生存率和生存率有改善趋势。多因素逐步Cox回归分析显示，LDH水平、Ann Arbor分期和原发性纵隔定位是无病生存率和生存率的独立有利预后因素。LDH水平和Ann Arbor分期也可预测疾病进展风险。
我们的结果表明，与其他类型的B细胞大细胞淋巴瘤相比，PML患者可能对大剂量化疗更敏感。这些发现若得到证实，可能对PML患者的初始治疗有影响。
