Incidence of transformation to aggressive lymphoma in limited-stage follicular lymphoma treated with radiotherapy
Incidence of transformation to aggressive lymphoma in limited-stage follicular lymphoma treated with radiotherapy
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DOI：
10.1093/annonc/mds433
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发表时间：
2013-02-01
影响因子：
50.5
通讯作者：
Savage, K. J.
中科院分区：
文献类型：
--
作者：
Bains, P.;Al Tourah, A.;Savage, K. J.
局限性滤泡性淋巴瘤的公认治疗方法是放射治疗(RT)。滤泡性淋巴瘤转化为侵袭性淋巴瘤存在固有的风险；然而，这种频率和对预后的影响在有限期患者中尚不清楚。我们确定了237例有限期滤泡性淋巴瘤患者进行了治疗性放射治疗。回顾病例以确定转化的频率和随后的生存。中位数为7.4年的随访期，10年转化的风险为18.5%。中位随访期4.7年，3年无进展生存率(PFS)和总生存率(OS)分别为42%和44%。与单纯联合化疗(78%比15%，P<；0.00001)和(87%比38.5%，P<；0.00001)相比，加入利妥昔单抗改善了转化后3年的PFS和OS(P<；0.00001)。在多变量分析中，只有利妥昔单抗与转化后的OS[HR0.07(95%CI 0.015-0.312，P=0.001)]和PFS[HR0.19(95%CI0.55-0.626，P=0.007)]相关。在转化时使用利妥昔单抗治疗似乎可以改善这一原本风险较低的人群的存活率。
The established treatment of limited-stage follicular lymphoma is radiotherapy (RT). There is an inherent risk of transformation of follicular lymphoma to aggressive lymphoma; however, the frequency and impact on the outcome are unknown in limited-stage patients.We identified 237 patients with limited-stage follicular lymphoma treated with curative intent RT. Cases were reviewed to determine the frequency of transformation and subsequent survival.With a median follow-up of 7.4 years, the 10-year risk of transformation was 18.5%. With a median follow-up after transformation of 4.7 years, the 3-year post-transformation progression-free survival (PFS) and overall survival (OS) were 42% and 44%, respectively. The addition of rituximab improved the 3-year post-transformation PFS and OS compared with combination chemotherapy alone (78% versus 15%, P < 0.00001) and (87% versus 38.5%, P < 0.00001), respectively. In multivariate analysis, only rituximab was associated with OS [HR 0.07 (95% CI 0.015-0.312, P = 0.001)] and PFS [HR 0.19 (95% CI 0.55-0.626, P = 0.007)] following transformation.There is a moderate risk of transformation in limited-stage follicular lymphoma treated with curative intent RT, and it substantially impacts outcome in these patients. Treatment with rituximab at the time of transformation appears to improve survival in this otherwise poor-risk population.