Guglielmi C, Gomez F, Philip T, Hagenbeek A, Martelli M, Sebban C, Milpied N, Bron D, Cahn J Y, Somers R, Sonneveld P, Gisselbrecht C, Van Der Lelie H, Chauvin F
Dipartimento di Biotecnologie Cellulari ed Ematologia, Università La Sapienza, Rome, Italy.
J Clin Oncol. 1998 Oct;16(10):3264-9. doi: 10.1200/JCO.1998.16.10.3264.
The purpose of this study was to investigate the prognostic value of time to relapse in 188 adult patients with intermediate- or high-grade non-Hodgkin's lymphoma (NHL) included on the Parma trial at the time of their first relapse.
The median follow-up of these patients is 102 months after registration onto the Parma study. Time to relapse was calculated from initial diagnosis, and a cutoff of 12 months was used to separate 77 patients defined as early relapse from 111 patients defined as late relapse.
Patients with early and late relapses had significantly different overall response rates to salvage therapy with two courses of dexamethasone, high-dose cytarabine, and cisplatin (DHAP; 40% v 69%; P=.00007) and different 8-year survival rates (13% v 29%; P=.00001). Features at relapse with a negative prognostic value in univariate analysis were higher than normal lactic dehydrogenase (LDH) levels, tumor size greater than 5 cm, Ann Arbor stages III to IV, and Karnofsky score less than 80%. Therefore, multivariate analyses were performed. Time to relapse (P=.001) and LDH levels at relapse (P=.003) had independent prognostic value, whereas tumor size did not reach statistical significance in the logistic model that predicted overall response after two courses of DHAP. The study of prognostic factors for overall survival (OS) and progression-free survival (PFS) confirmed the prognostic value of time to relapse (P < .0001 for OS and P=.005 for PFS) independent of response or treatment after two courses of DHAP.
Time to relapse may be used to stratify patients at time of first relapse of intermediate to high-grade non-Hodgkin's lymphoma.
本研究旨在探讨188例中度或高度非霍奇金淋巴瘤（NHL）成年患者在帕尔马试验首次复发时的复发时间的预后价值。
这些患者在登记参加帕尔马研究后的中位随访时间为102个月。复发时间从初始诊断开始计算，采用12个月的临界值将77例定义为早期复发的患者与111例定义为晚期复发的患者区分开来。
早期和晚期复发患者接受两疗程地塞米松、大剂量阿糖胞苷和顺铂（DHAP）挽救治疗的总缓解率显著不同（40%对69%；P = 0.00007），8年生存率也不同（13%对29%；P = 0.00001）。单因素分析中具有负性预后价值的复发特征包括乳酸脱氢酶（LDH）水平高于正常、肿瘤大小大于5 cm、Ann Arbor分期III至IV期以及卡诺夫斯基评分低于80%。因此，进行了多因素分析。复发时间（P = 0.001）和复发时的LDH水平（P = 0.003）具有独立的预后价值，而在预测两疗程DHAP后的总缓解率的逻辑模型中，肿瘤大小未达到统计学意义。对总生存（OS）和无进展生存（PFS）的预后因素研究证实了复发时间的预后价值（OS为P < 0.0001，PFS为P = 0.005），独立于两疗程DHAP后的缓解或治疗情况。
复发时间可用于对中度至高度非霍奇金淋巴瘤首次复发时的患者进行分层。
