Addition of rituximab to chemotherapy alone as first-line therapy improves overall survival in elderly patients with mantle cell lymphoma
Addition of rituximab to chemotherapy alone as first-line therapy improves overall survival in elderly patients with mantle cell lymphoma
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DOI：
10.1182/blood-2011-04-348367
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发表时间：
2011-11-03
期刊：
影响因子：
20.3
通讯作者：
Dreyling, Martin
中科院分区：
文献类型：
--
作者：
Griffiths, Robert;Mikhael, Joseph;Dreyling, Martin
临床试验表明，利妥昔单抗可提高非霍奇金淋巴瘤（NHL）的总生存率，但套细胞淋巴瘤（MCL）除外。我们使用监测流行病学和最终结果（SEER）-医疗保险数据来比较老年MCL患者的生存率，这些患者在诊断后180天内开始使用或不使用利妥昔单抗进行化疗。从诊断（1999年1月至2005年12月）至死亡或观察结束（2007年12月）对患者进行随访。医疗保险管理和索赔数据用于确定死亡日期和原因以及免疫化疗方案。在638例患者中，诊断时的平均年龄为75岁，75%患有III/IV期疾病，67%有结节受累，64%接受利妥昔单抗治疗。一线治疗的平均时间为21周，两组之间无差异（P = .76）。单用化疗的中位生存期为27个月，而化疗加利妥昔单抗的中位生存期为37个月（P < .001）。在2年生存率的多变量分析中，利妥昔单抗联合化疗与较低的全因死亡率（风险比[HR] 0.58; 95%置信区间[CI] 0.41-0.82; P <0.01）和癌症特异性死亡率（HR 0.56; 95% CI 0.37-0.84; P <0.01）相关。当使用整个观察期、倾向评分分析和将化疗限制为CHOP/CHOP样时，结果相似。我们的结论是，一线化疗包括利妥昔单抗与显着改善生存老年MCL患者诊断。（血。2011;118（18）：4808-4816）
Clinical trials have demonstrated that rituximab improves overall survival in non-Hodgkin lymphoma (NHL), except in mantle cell lymphoma (MCL). We used Surveillance Epidemiology and End Results (SEER)-Medicare data to compare survival in older MCL patients who began chemotherapy with or without rituximab within 180 days of diagnosis. Patients were followed from diagnosis (January 1999 to December 2005) until death or the end of observation (December 2007). Medicare administrative and claims data were used to identify the date and cause of death and the immunochemotherapy regimen. Of 638 patients, the mean age at diagnosis was 75 years, 75% had stage III/IV disease, 67% had extranodal involvement, and 64% received rituximab. The average length of first-line treatment was 21 weeks, with no difference between the 2 groups (P = .76). Median survival was 27 months for chemotherapy alone, compared with 37 months for chemotherapy plus rituximab (P < .001). In multivariate analysis of 2-year survival, rituximab plus chemotherapy was associated with lower all-cause (hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.41-0.82; P < .01), and cancer-specific (HR 0.56; 95% CI 0.37-0.84; P < .01) mortality. Results were similar when using the entire observation period, propensity score analysis, and limiting chemotherapy to CHOP/CHOP-like. We conclude that first-line chemotherapy including rituximab is associated with significantly improved survival in older patients diagnosed with MCL. (Blood. 2011;118(18):4808-4816)