Fractionated ifosfamide, carboplatin, and etoposide with rituximab as a safe and effective treatment for relapsed/refractory diffuse large B cell lymphoma with severe comorbidities
Fractionated ifosfamide, carboplatin, and etoposide with rituximab as a safe and effective treatment for relapsed/refractory diffuse large B cell lymphoma with severe comorbidities
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分次异环磷酰胺、卡铂和依托泊苷联合利妥昔单抗可安全有效地治疗伴有严重合并症的复发/难治性弥漫性大 B 细胞淋巴瘤
DOI：
10.1007/s00277-020-04267-0
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发表时间：
2020
影响因子：
3.5
通讯作者：
Tanaka Junji
中科院分区：
文献类型：
--
作者：
Tanaka Norina;Imai Yoichi;Yoshinaga Kentaro;Shiseki Masayuki;Tanaka Junji
尽管随着利妥昔单抗的引入，弥漫性大B细胞淋巴瘤（DLBCL）的治疗结果有所改善，但约一半的患者会出现复发/难治性（r/r）疾病。此外，迄今为止尚未建立标准的挽救治疗，而由于毒性和老年患者和/或合并症患者的耐受性有限，治疗选择存在局限性。ICE（异环磷酰胺、环磷酰胺和依托泊苷）方案常用作r/r DLBCL的挽救治疗。有几种不需要持续输注异环磷酰胺的改良ICE方案，可用于门诊。本研究分析了在47例复发性/难治性DLBCL患者（开始f-R-ICE治疗时的中位年龄为71岁）中，分次ICE联合利妥昔单抗（f-R-ICE）作为挽救治疗方案的疗效和毒性。整个队列的总体（ORR）和完全缓解率分别为53.1%（n= 25）和25.5%（n= 12），f-R-ICE启动后的估计1年总生存率为57%。在f-R-ICE开始时使用Charlson合并症指数（CCI）评价合并症。在f-R-ICE启动时，CCI评分低的患者（68%）的ORR高于CCI评分高的患者（36.4%）（P= 0.042）。相比之下，在开始f-R-ICE后，低CCI组和高CCI组之间的总生存期（OS）无显著差异（1年OS 56.6% vs. 52.2%;中位OS 24 vs. 22.8个月）。我们的研究结果表明，f-R-ICE是r/r DLBCL的安全有效的挽救治疗，可用于老年患者和/或门诊CCI评分高的患者。
Although treatment outcomes for diffuse large B cell lymphoma (DLBCL) have improved with the introduction of rituximab, approximately half of patients experience relapsed/refractory (r/r) disease. Furthermore, no standard salvage therapy has yet been established to date, while limitations in treatment options exist due to toxicity and restricted tolerability among elderly patients and/or those with comorbidities. The ICE (ifosfamide, cyclophosphamide, and etoposide) regimen is often used as salvage therapy for r/r DLBCL. Several modified ICE regimens not requiring continuous ifosfamide infusion are available, which can be used in outpatient clinics. This study analyzed the efficacy and toxicity of fractionated ICE with rituximab (f-R-ICE) as a salvage regimen among 47 patients with relapsed/refractory DLBCL (median age upon f-R-ICE initiation, 71 years). The whole cohort had an overall (ORR) and complete response rate of 53.1% (n= 25) and 25.5% (n= 12), respectively, and an estimated 1-year overall survival after f-R-ICE initiation of 57%. Comorbidities were evaluated using the Charlson Comorbidity Index (CCI) upon f-R-ICE initiation. Patients with low CCI scores (68%) had a higher ORR than those with high CCI scores (36.4%) upon f-R-ICE initiation (P= 0.042). In contrast, no significant differences in overall survival (OS) were observed between the low and high CCI groups (1-year OS 56.6% vs. 52.2%; median OS 24 vs. 22.8 months) after initiating f-R-ICE. Our results suggest that f-R-ICE is a safe and effective salvage therapy for r/r DLBCL and can be used for older patients and/or those with high CCI scores in outpatient clinics.
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影响因子：
20.3
作者：
Kewalramani, T;Zelenetz, AD;Moskowitz, CH
通讯作者：
Moskowitz, CH
影响因子：
8.4
作者：
Boddy, AV;English, M;Skinner, R
通讯作者：
Skinner, R
高剂量异环磷酰胺、卡铂和依托泊苷在淋巴瘤和实体瘤中自体骨髓挽救的 I 期和 II 期研究。
DOI：
10.1200/jco.1992.10.11.1712
发表时间：
1992
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
W. Wilson;V. Jain;G. Bryant;K. Cowan;C. Carter;M. Cottler;B. Goldspiel;S. Steinberg;D. Longo;R. Wittes
通讯作者：
R. Wittes
影响因子：
45.3
作者：
Moskowitz, CH;Bertino, JR;Zelenetz, AD
通讯作者：
Zelenetz, AD
影响因子：
20.3
作者：
Crump, Michael;Neelapu, Sattva S.;Gisselbrecht, Christian
通讯作者：
Gisselbrecht, Christian