Is there any role for transplantation in the rituximab era for diffuse large B-cell lymphoma?
Is there any role for transplantation in the rituximab era for diffuse large B-cell lymphoma?
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DOI：
10.1182/asheducation-2012.1.410
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发表时间：
2012-12-01
期刊：
影响因子：
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通讯作者：
Gisselbrecht, Christian
中科院分区：
文献类型：
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作者：
Gisselbrecht, Christian
挽救性化疗随后进行高剂量治疗和自体干细胞移植是弥漫性大 B 细胞淋巴瘤化疗敏感性复发的标准治疗方法。在化疗中添加利妥昔单抗可提高一线治疗和复发后的缓解率和无失败生存率。尽管对于最佳挽救方案尚未达成共识，但预计复发率会减少。复发性侵袭性淋巴瘤组间协作试验 (CORAL) 在首先比较 2 种挽救方案后，为这一治疗标准设定了限制：利妥昔单抗、异环磷酰胺、依托泊苷和卡铂 (R-ICE) 以及利妥昔单抗、地塞米松、阿西汀和顺铂 (R-DHAP)。这些挽救方案之间的缓解率或生存率没有差异。有几个因素影响生存：既往接受利妥昔单抗治疗、早期复发（< 12 个月）和次要国际预后指数评分为 2-3。对于具有 2 个因素的患者，挽救反应率仅为 46%，这很容易识别出预后较差的组。此外，ABC 亚型或 c-MYC 易位的患者对治疗反应不佳。超过 70% 的患者不会从标准挽救治疗中受益，需要继续取得进展。本文讨论了评估移植后免疫治疗的研究，包括同种异体移植、放射免疫治疗的新预处理方案以及基于弥漫性大 B 细胞淋巴瘤亚型的其他化疗组合。早期复发和/或对前期基于利妥昔单抗的化疗无效的患者的反应率和预后较差。有必要对这些患者和新方法有更好的生物学了解。
Salvage chemotherapy followed by high-dose therapy and autologous stem cell transplantation is the standard of treatment for chemosensitive relapses in diffuse large B-cell lymphoma. The addition of rituximab to chemotherapy has improved the response rate and failure-free survival after first-line treatment and relapses. Fewer relapses are expected, although there is no consensus on the best salvage regimen. The intergroup Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) set the limits for this standard of treatment after first comparing 2 salvage regimens: rituximab, ifosfamide, etoposide, and carboplatin (R-ICE) and rituximab, dexamethasone, aracytine, and cisplatin (R-DHAP). There was no difference in response rates or survivals between these salvage regimens. Several factors affected survival: prior treatment with rituximab, early relapse (< 12 months), and a secondary International Prognostic Index score of 2-3. For patients with 2 factors, the response rate to salvage was only 46%, which identified easily a group with poor outcome. Moreover, patients with an ABC subtype or c-MYC translocation responded poorly to treatment. More than 70% of patients will not benefit from standard salvage therapy, and continued progress is needed. Studies evaluating immunotherapy after transplantation, including allotransplantation, new conditioning regimens with radioimmunotherapy and other combinations of chemotherapy based on diffuse large B-cell lymphoma subtype, are discussed herein. Early relapses and/or patients refractory to upfront rituximab-based chemotherapy have a poor response rate and prognosis. A better biological understanding of these patients and new approaches are warranted.