Early Relapse of Follicular Lymphoma After Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone Defines Patients at High Risk for Death: An Analysis From the National LymphoCare Study
Early Relapse of Follicular Lymphoma After Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone Defines Patients at High Risk for Death: An Analysis From the National LymphoCare Study
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DOI：
10.1200/jco.2014.59.7534
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发表时间：
2015-08-10
影响因子：
45.3
通讯作者：
Friedberg, Jonathan W.
中科院分区：
文献类型：
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作者：
Casulo, Carla;Byrtek, Michelle;Friedberg, Jonathan W.
目的：20%的滤泡性淋巴瘤（FL）患者在首次化疗免疫治疗后2年内出现疾病进展（POD）。我们分析了来自国家淋巴护理研究的数据，以确定预后FL因素是否与早期POD相关，以及早期POD患者是否有较高的死亡风险。患者和方法共有588例2 - 4期FL患者接受了一线利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和强的松（R-CHOP）治疗。定义两组：诊断后2年及以下的早期POD患者和2年内无POD的对照组。对147例接受一线R-CHOP治疗的FL患者进行独立验证，分析其可重复性。结果588例患者中，19% （n = 110）为早期POD， 71% （n = 420）为参照组，8% （n = 46）失访，2% （n = 12）在诊断后2年内无POD死亡。早期pod组的5年总生存率低于对照组（50% vs 90%）。在我们调整FL国际预后指数后，这一趋势仍保持不变（风险比，6.44;95% CI， 4.33至9.58）。验证组的结果相似（FL国际预后指数校正风险比，19.8）。结论：在接受一线R-CHOP治疗的FL患者中，诊断后2年内的POD与不良预后相关，应进一步验证其作为未经治疗的FL化疗免疫治疗试验的标准终点。该高危FL人群值得在定向前瞻性临床试验中进一步研究。
PurposeTwenty percent of patients with follicular lymphoma (FL) experience progression of disease (POD) within 2 years of initial chemoimmunotherapy. We analyzed data from the National LymphoCare Study to identify whether prognostic FL factors are associated with early POD and whether patients with early POD are at high risk for death.Patients and MethodsIn total, 588 patients with stage 2 to 4 FL received first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Two groups were defined: patients with early POD 2 years or less after diagnosis and those without POD within 2 years, the reference group. An independent validation set, 147 patients with FL who received first-line R-CHOP, was analyzed for reproducibility.ResultsOf 588 patients, 19% (n = 110) had early POD, 71% (n = 420) were in the reference group, 8% (n = 46) were lost to follow-up, and 2% (n = 12) died without POD less than 2 years after diagnosis. Five-year overall survival was lower in the early-POD group than in the reference group (50% v 90%). This trend was maintained after we adjusted for FL International Prognostic Index (hazard ratio, 6.44; 95% CI, 4.33 to 9.58). Results were similar for the validation set (FL International Prognostic Index-adjusted hazard ratio, 19.8).ConclusionIn patients with FL who received first-line R-CHOP, POD within 2 years after diagnosis was associated with poor outcomes and should be further validated as a standard end point of chemoimmunotherapy trials of untreated FL. This high-risk FL population warrants further study in directed prospective clinical trials.