New treatment options have changed the survival of patients with follicular lymphoma
New treatment options have changed the survival of patients with follicular lymphoma
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DOI：
10.1200/jco.2005.03.1674
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发表时间：
2005-11-20
影响因子：
45.3
通讯作者：
Miller, TP
中科院分区：
文献类型：
--
作者：
Fisher, RI;LeBlanc, M;Miller, TP
滤泡性淋巴瘤的自然史被认为在过去30年中没有改变。中位生存期为7至10年，这种疾病被认为是无法治愈的。然而，在过去的十年中，已经开发了多种新的治疗方案，其对滤泡性淋巴瘤生存率的影响仍然未知。患者和方法在目前的分析中，我们确定了所有以前未经治疗的晚期滤泡性淋巴瘤患者，采用以下三种序贯治疗方法进行治疗：环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP）化疗+/-非特异性免疫刺激剂（西南肿瘤学小组[SWOG] 7426和7713：1974年至1983年）;泼尼松、甲氨蝶呤、阿霉素、环磷酰胺和依托泊苷（ProMACE）加氮芥、长春新碱、丙卡巴嗪和泼尼松（MOPP）+/-干扰素（SWOG 8809：1988 - 1994）;以及CHOP后进行单克隆抗体（MoAb）治疗（SWOG 9800和9911：1998 - 2000）。我们评估了患者的无进展生存期（PFS）和总生存期（OS）。结果CHOP和ProMACE-MOPP研究的PFS曲线重叠，4年PFS估计值分别为46%和48%。然而，CHOP + MoAb研究的PFS率显著改善为61%（P =.005）。OS曲线显示每项后续研究均有所改善。CHOP方案的4年OS估计值为69%，ProMACE-MOPP研究为79%，CHOP + MoAb方案为91%（P <.001）。这些结论被保留后调整的研究groups.Conclusion预后因素的差异，本研究的结果表明，OS与滤泡性淋巴瘤患者随着时间的推移有所改善，初始治疗的选择可能很重要。
Background The natural history of follicular lymphoma is believed not to have changed over the last 30 years. Median survivals have ranged from 7 to 10 years, and the disease is considered incurable. However, multiple new treatment options have been developed in the last decade, and their impact on survival of follicular lymphoma remains unknown.Patients and Methods In the current analysis, we identified all previously untreated, advanced-stage, follicular lymphoma patients treated with the following three sequential treatment approaches: cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy +/- nonspecific immunostimulants (Southwest Oncology Group [SWOG] 7426 and 7713: 1974 to 1983); prednisone, methotrexate, doxorubicin, cyclophosphamide, and etoposide (ProMACE) plus mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) +/- interferon (SWOG 8809: 1988 to 1994); and CHOP followed by monoclonal antibody (MoAb) therapy (SWOG 9800 and 9911: 1998 to 2000). We assessed the patients' progression-free survival (PFS) and overall survival (OS). The MoAb trials included CHOP followed by rituximab (SWOG 9800) and CHOP followed by I-131-tositumomab (SWOG 9911).Results The PFS curves for the CHOP and ProMACE-MOPP studies are overlapping, with 4-year PFS estimates of 46% and 48%, respectively. However, the PFS rate of the CHOP + MoAb studies is significantly improved at 61% (P = .005). The OS curves show improvement with each succeeding study. The 4-year estimate of OS is 69% for the CHOP regimens 79% for, the ProMACE-MOPP study, and 91% for the CHOP + MoAb regimens (P < .001). These conclusions were retained after adjusting for differences in prognostic factors between the study groups.Conclusion The results of this study suggest that OS for patients with follicular lymphoma has improved over time and that the choice of initial therapy may matter.