Addition of rituximab to standard chemotherapy improves the survival of both the germinal center B-cell-like and non-germinal center B-cell-like subtypes of diffuse large B-cell lymphoma
Addition of rituximab to standard chemotherapy improves the survival of both the germinal center B-cell-like and non-germinal center B-cell-like subtypes of diffuse large B-cell lymphoma
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DOI：
10.1200/jco.2007.15.9277
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发表时间：
2008-10-01
影响因子：
45.3
通讯作者：
Vose, Julie M.
中科院分区：
文献类型：
--
作者：
Fu, Kai;Weisenburger, Dennis D.;Vose, Julie M.
目的弥漫性大B细胞淋巴瘤(DLBCL)至少包括两种预后重要的亚型(即生发中心B细胞样[GCB]和活化B细胞样[ABC]DLBCL)，最初以基因表达谱为特征，随后经免疫染色证实。我们研究了243例初治DLBCL患者，其中131例接受利妥昔单抗联合标准化疗(利妥昔单抗组)，112例仅接受标准化疗(对照组)。根据免疫表型将病例分为GCB亚型和非GCB亚型(后者包括ABC DLBCL和无法分类的DLBCL)。结果利妥昔单抗治疗组和对照组患者的临床特征相似。与对照组相比，加用利妥昔单抗可提高DLBCL患者的3年总存活率(OS；42%比77%；P<；.001)。无论是GCB亚组还是非GCB亚组，接受利妥昔单抗治疗的患者与对照组中各自的亚组相比，3年的OS也有显著改善(P<；.001)。在利妥昔单抗组中，GCB亚组的3年OS显著好于非GCB亚组(85%比69%；P=.032)。多变量分析证实利妥昔单抗治疗对GCB和非GCB亚组的生存均有预测作用。结论在这项回顾性研究中，我们已经表明，在利妥昔单抗时代，基于起源细胞的DLBCL亚型仍然具有预后重要性。
PurposeDiffuse large B-cell lymphoma (DLBCL) includes at least two prognostically important subtypes (ie, germinal center B-cell-like [GCB] and activated B-cell -like [ABC] DLBCL), which initially were characterized by gene expression profiling and subsequently were confirmed by immunostaining. However, with the addition of rituximab to standard chemotherapy, the prognostic significance of this subclassification of DLBCL is unclear.Patients and MethodsWe studied 243 patient cases of de novo DLBCL, which included 131 patient cases treated with rituximab plus standard chemotherapy (rituximab group) and 112 patient cases treated with only standard chemotherapy (control group). The cases were assigned to GCB or non-GCB subgroups (the latter of which included both ABC DLBCL and unclassifiable DLBCL) on the basis of immunophenotype by using the Hans method. Clinical characteristics and survival outcomes of the two patient groups were compared.ResultsThe clinical characteristics of the patients in the rituximab and the control groups were similar. Compared with the control group, addition of rituximab improved the 3-year overall survival (OS; 42% v 77%; P < .001) of patients with DLBCL. Rituximab-treated patients in either the GCB or the non-GCB subgroups also had a significantly improved 3-year OS compared with their respective subgroups in the control group (P < .001). In the rituximab group, the GCB subgroup had a significantly better 3-year OS than the non-GCB subgroup (85% v 69%; P = .032). Multivariate analyses confirmed that rituximab treatment was predictive for survival in both the GCB and the non-GCB subgroups.ConclusionIn this retrospective study, we have shown that the subclassification of DLBCL on the basis of the cell of origin continues to have prognostic importance in the rituximab era.