De novo CD5+ diffuse large B-cell lymphoma: Adverse outcomes with and without stem cell transplantation in a large, multicenter, rituximab treated cohort.
De novo CD5+ diffuse large B-cell lymphoma: Adverse outcomes with and without stem cell transplantation in a large, multicenter, rituximab treated cohort.
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DOI：
10.1002/ajh.24299
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发表时间：
2016-06
影响因子：
12.8
通讯作者：
Blum KA
中科院分区：
文献类型：
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作者：
Alinari L;Gru A;Quinion C;Huang Y;Lozanski A;Lozanski G;Poston J;Venkataraman G;Oak E;Kreisel F;Park SI;Matthews S;Abramson JS;Iris Lim H;Martin P;Cohen JB;Evens A;Al-Mansour Z;Singavi A;Fenske TS;Blum KA
原发性CD 5+弥漫性大B细胞淋巴瘤（DLBCL）是DLBCL的一个独特亚组，预后不良。然而，含利妥昔单抗的治疗和补救性干细胞移植在该患者人群中的作用仍有待确定。我们回顾性分析了102例在9个不同机构接受含利妥昔单抗治疗的原发性CD 5 + DLBCL患者的临床特征和结局。按Hans的标准，64例患者为活化B细胞（ABC）亚型，24例为老年中心B细胞（GCB）亚型，14例未评估。没有患者发生myc易位。83例患者接受利妥昔单抗、环磷酰胺、多柔比星、长春新碱、泼尼松（R-CHOP）治疗，7例患者接受利妥昔单抗、依托泊苷、环磷酰胺、多柔比星、长春新碱、泼尼松（R-EPOCH）治疗，6例患者接受R-CHOP联合甲氨蝶呤（3 g/m2）治疗。对一线治疗的总体应答率为85%。所有患者的3年无进展生存期（PFS）和总生存期（OS）分别为40%和65%。ABC和GCB亚型的3年PFS分别为34%和45%。ABC和GCB亚型的3年OS分别为62%和67%。ABC亚型和GCB亚型至第二次治疗失败的中位时间分别为3个月和1个月。28例（71%）自体、异体或两者移植患者复发。这项研究证实了一个大型多中心队列中的新发CD 5 + DLBCL预后不良，尽管最初接受了含利妥昔单抗的化疗，并表明干细胞移植未能挽救大多数这些患者。该DLBCL患者亚组需要预防复发的方法和/或复发性疾病的新疗法。
De novo CD5+ diffuse large B-cell lymphomas (DLBCL) are a distinct subgroup of DLBCL with poor prognosis. However the role of rituximab-containing therapy and salvage stem cell transplantation in this patients’ population remain to be defined. We retrospectively reviewed clinical features and outcomes of 102 patients with de novo CD5+ DLBCL treated with rituximab-containing therapy at 9 different institutions. By Hans’ criteria, 64 patients had activated B-cell (ABC) subtype, 24 germinal center B-cell (GCB) subtype, and 14 were not evaluated. No patients had a myc translocation. Eighty-three patients were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP), 7 with rituximab, etoposide, cyclophosphamide, doxorubicin, vincristine, prednisone (R-EPOCH) and 6 with R-CHOP with methotrexate, 3 g/m2. The overall response rate to frontline therapy was 85%. The 3-year progression free survival (PFS) and overall survival (OS) for all patients were 40% and 65%, respectively. The 3-year PFS for ABC- and GCB-subtypes was 34% and 45%, respectively. The 3-year OS for ABC- and GCB-subtypes was 62% and 67%, respectively. The median time to second treatment failure was 3 months and 1 month for ABC- and GCB-subtypes, respectively. Twenty of 28 (71%) transplanted patients with autologous, allogeneic, or both, relapsed. This study confirms the poor prognosis of de novo CD5+ DLBCL in a large multi-center cohort despite initial rituximab-containing chemotherapy and suggests that stem cell transplantation fails to salvage the majority of these patients. Approaches to prevent recurrence and/or novel therapies for relapsed disease are needed for this subgroup of DLBCL patients.