Transformed non-Hodgkin lymphoma in the rituximab era: analysis of the NCCN outcomes database
Transformed non-Hodgkin lymphoma in the rituximab era: analysis of the NCCN outcomes database
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DOI：
10.1111/bjh.12570
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发表时间：
2013-11-01
影响因子：
6.5
通讯作者：
Friedberg, Jonathan W.
中科院分区：
文献类型：
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作者：
Ban-Hoefen, Makiko;Vanderplas, Ann;Friedberg, Jonathan W.
组织学转化（HT）是惰性非霍奇金淋巴瘤（NHL）患者发病和死亡的主要原因。NHL的多中心国家癌症综合网络数据库为研究利妥昔单抗时代HT的自然史提供了独特的机会。确定了118例活检证实的惰性淋巴瘤和随后活检证实的HT患者。HT的治疗包括自体干细胞移植（auto-SCT）（n=50）、同种异体SCT（allo-SCT）（n=18）和无移植治疗（n=50）。整个队列的2年总生存率（OS）为68%。对于年龄60岁的auto-SCT患者（n=24），2年OS为74%。对于年龄60岁的非移植患者（n=19），2年OS为59%。HT前未接受过化疗的患者的2年OS优于HT前接受过化疗的患者（100% vs. 35%，P= 0.03）。在利妥昔单抗时代严格定义的HT患者的最大前瞻性队列中，HT的自然史似乎比历史研究更有利。在HT之前未暴露于化疗的年轻患者即使没有移植也经历了延长的生存期。这项研究作为利妥昔单抗时代HT新方法未来试验的基准。
Histological transformation (HT) is a major cause of morbidity and mortality in patients with indolent non-Hodgkin lymphoma (NHL). The multicentre National Cancer Comprehensive Network database for NHL provides a unique opportunity to investigate the natural history of HT in the rituximab era. 118 patients with biopsy-confirmed indolent lymphoma and subsequent biopsy-confirmed HT were identified. Treatments for HT included autologous stem-cell transplant (auto-SCT) (n=50), allogeneic SCT (allo-SCT) (n=18), and treatment without transplant (n=50). The 2-year overall survival (OS) for the entire cohort was 68%. For auto-SCT patients aged 60years (n=24), the 2-year OS was 74%. For non-transplanted patients aged 60years (n=19), the 2-year OS was 59%. The 2-year OS of patients naive to chemotherapy prior to HT was superior to patients who were exposed to chemotherapy prior to HT (100% vs. 35%, P=003). In this largest prospective cohort of patients of strictly defined HT in the rituximab era, the natural history of HT appears more favourable than historical studies. Younger patients who were not exposed to chemotherapy prior to HT experienced a prolonged survival even without transplantation. This study serves as a benchmark for future trials of novel approaches for HT in the Rituximab era.