Long-Term Course of Patients With Stage IA Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the German Hodgkin Study Group
Long-Term Course of Patients With Stage IA Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the German Hodgkin Study Group
复制标题
DOI：
10.1200/jco.2014.60.4363
复制
发表时间：
2015-09-10
影响因子：
45.3
通讯作者：
Engert, Andreas
中科院分区：
文献类型：
--
作者：
Eichenauer, Dennis A.;Pluetschow, Annette;Engert, Andreas
目的 IA 期结节性淋巴细胞为主型霍奇金淋巴瘤 (NLPHL) 的最佳治疗尚不明确。因此，我们使用德国霍奇金研究组的数据库进行了分析。 患者和方法评估了 256 名 IA 期 NLPHL 患者的长期结果。 1988 年至 2009 年间，患者接受过德国霍奇金研究组临床试验方案中的联合治疗 (CMT；n = 72)、大范围放射治疗 (EF-RT；n = 49)、累及野放射治疗 (IF-RT；n = 108) 或每周四次标准剂量的利妥昔单抗 (n = 27)。 结果 NLPHL 诊断时的中位年龄为 39 岁（范围， 16 至 75 岁）。大多数患者是男性（76%）。整个患者组的中位随访时间为 91 个月（CMT：95 个月；EF-RT：110 个月；IF-RT：87 个月；利妥昔单抗：49 个月）。 8 年时，CMT 的无进展生存率和总生存率分别为 88.5% 和 98.6%，EF-RT 的无进展生存率和总生存率分别为 84.3% 和 95.7%，IF-RT 的无进展生存率和总生存率分别为 91.9% 和 99.0%。使用利妥昔单抗治疗的患者的 4 年无进展生存率和总生存率分别为 81.0% 和 100%。 256 名患者中有 17 名 (6.6%) 在随访过程中被诊断出患有第二种恶性肿瘤。共有12人死亡。然而，只有一名患者死于 NLPHL。 结论 本分析中的肿瘤控制与 CMT、EF-RT 和 IF-RT 相当。因此，IF-RT 与发生毒性反应的风险最低有关，应被视为 IA 期 NLPHL 患者的标准治疗。单独使用利妥昔单抗会增加该患者群体的复发风险。 (C) 2015 年美国临床肿瘤学会
PurposeThe optimal treatment of stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is not well defined. Thus, we performed an analysis using the database of the German Hodgkin Study Group.Patients and MethodsThe long-term outcome of 256 patients with stage IA NLPHL was evaluated. Patients had received combined-modality treatment (CMT; n = 72), extended-field radiotherapy (EF-RT; n = 49), involved-field radiotherapy (IF-RT; n = 108), or four weekly standard doses of rituximab (n = 27) within German Hodgkin Study Group clinical trial protocols between 1988 and 2009.ResultsThe median age at NLPHL diagnosis was 39 years (range, 16 to 75 years). Most patients were male (76%). The whole patient group had a median follow-up of 91 months (CMT: 95 months; EF-RT: 110 months; IF-RT: 87 months; rituximab: 49 months). At 8 years, progression-free survival and overall survival rates were 88.5% and 98.6% for CMT, 84.3% and 95.7% for EF-RT, and 91.9% and 99.0% for IF-RT, respectively. Patients treated with rituximab had 4-year progression-free and overall survival rates of 81.0% and 100%, respectively. A second malignancy during the course of follow-up was diagnosed in 17 (6.6%) of 256 patients. A total of 12 deaths occurred. However, only one patient died from NLPHL.ConclusionTumor control in this analysis was equivalent with CMT, EF-RT, and IF-RT. Therefore, IF-RT, which is associated with the lowest risk for the development of toxic effects, should be considered as standard of care for patients with stage IA NLPHL. Rituximab alone is associated with an increased risk of relapse in this patient population. (C) 2015 by American Society of Clinical Oncology