PROGNOSTIC-SIGNIFICANCE OF ACTUAL DOSE INTENSITY IN DIFFUSE LARGE-CELL LYMPHOMA - RESULTS OF A TREE-STRUCTURED SURVIVAL ANALYSIS
PROGNOSTIC-SIGNIFICANCE OF ACTUAL DOSE INTENSITY IN DIFFUSE LARGE-CELL LYMPHOMA - RESULTS OF A TREE-STRUCTURED SURVIVAL ANALYSIS
复制标题
DOI：
10.1200/jco.1990.8.6.963
复制
发表时间：
1990-06-01
影响因子：
45.3
通讯作者：
HORNING, SJ
中科院分区：
文献类型：
--
作者：
KWAK, LW;HALPERN, J;HORNING, SJ
虽然弥漫性大细胞淋巴瘤（DLCL）被认为是高度可治愈的目前的治疗，治疗失败，甚至与密集的联合化疗方案观察。为了研究DLCL患者化疗实际剂量强度的预后意义，我们回顾性分析了1975年至1986年在斯坦福大学接受环磷酰胺、阿霉素和环磷酰胺治疗的115例未经治疗的DLCL患者。（阿霉素，Adria Laboratories，哥伦布，OH）、长春新碱和泼尼松（CHOP）、甲氨蝶呤、博来霉素、阿霉素、环磷酰胺、长春新碱和地塞米松（[M]BACOD）或甲氨蝶呤、阿霉素、环磷酰胺、长春新碱、泼尼松和博来霉素（MACOP-B）。计算实际相对剂量强度（RDI），即在前12周治疗期间实际给予每例患者的药物量，标准化为CHOP，并通过单变量分析与预后生存的临床因素一起进行分析。多变量递归分割（树形结构）生存分析确定阿霉素的实际RDI大于75%是生存的单一最重要的预测因子。一个模型结合了阿霉素的急性RDI和体能状态，结合血清乳酸脱氢酶（LDH）和结节病，定义了三个总体预后组的患者，3年生存率分别为89%，63%和18%。三个预后组仍然是不同的，即使仅限于完全缓解者。当相对于三种方案中每种方案定义的最佳剂量分析剂量强度时，以及当应用于50岁或以下患者亚组时，该模型也可预测生存率。我们的结论是，实际RDI是DLCL患者生存的一个重要预后因素，在治疗过程中早期分析RDI可能会允许修改治疗计划。
While diffuse large-cell lymphoma (DLCL) is considered to be highly curable with current therapy, treatment failures are observed even with intensive combination chemotherapy regimens. In order to study the prognostic significance of actual dose intensity of chemotherapy in DLCL, we retrospectively analyzed 115 previously untreated patients treated at Standford between 1975 and 1986 with cyclophosphamide, Adriamycin (doxorubicin, Adria Laboratories, Columbus, OH), vincristine, and prednisone (CHOP), methotrexate, bleomycin, Adriamycin, cyclophosphamide, vincristine, and dexamethasone ([M]BACOD), or methotrexate, Adriamycin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B). The actual relative dose intensity (RDI), the amount of drug actually administered to each patient during the first 12 weeks therapy, was calculated as standardized to CHOP and analyzed in addition to clinical factors prognostic for survival by univariate anlaysis. Multivariate recursive partitioning (tree-structured) survival analysis identified the actual RDI of Adriamycin greater than 75% as the single most important predictor of survival. A model incorporating the acutal RDI of Adriamycin and performance status, in combination with serum lactate dehydrogenase (LDH) and extranodal disease, defined three overall prognostic groups of patients with respective 3-year survival rates of 89%, 63%, and 18%. The three prognostic groups remained distinct, even when restricted to complete responders. This model was also predictive of survival when dose intensity was analyzed relative to the optimum dose defined for each of the three regimens and when applied to a subgroup of patients aged 50 years or younger. We conclude that actual RDI is an important prognostic factor for survival in DLCL and that analysis of RDI early in the course of treatment may allow modification of the treatment plan.