High-dose chemotherapy for relapsed and refractory diffuse large B-cell lymphoma: Mediastinal localization predicts for a favorable outcome
High-dose chemotherapy for relapsed and refractory diffuse large B-cell lymphoma: Mediastinal localization predicts for a favorable outcome
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DOI：
10.1200/jco.1998.16.1.63
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发表时间：
1998-01-01
影响因子：
45.3
通讯作者：
van Besien, K
中科院分区：
文献类型：
--
作者：
Popat, U;Przepiork, D;van Besien, K
目的：本研究旨在评估弥漫性B细胞大细胞淋巴瘤患者接受大剂量化疗和自体移植的结果，特别是评估原发性纵隔定位对大剂量化疗结果的影响。患者和方法：对所有接受自体骨髓或外周血干细胞移植的弥漫性大B细胞淋巴瘤患者进行了回顾性分析，结果：90例患者中原发性纵隔B细胞大细胞淋巴瘤（PML）31例（34%）。无病生存期、总生存期和疾病进展的累积概率分别为40%（95%置信区间[CI]，29 - 51）、42%（95% CI，31 - 53）和52%（95% CI，40 - 64）。通过单因素分析，低乳酸脱氢酶（LDH）水平和移植时低安阿伯分期与生存率和无病生存率的改善相关。PML患者的无病生存期和生存期有改善的趋势。多因素逐步考克斯回归分析显示LDH水平、安阿伯分期和原发纵隔部位是影响无病生存和生存的独立预后因素。LDH水平和安阿伯阶段也预测疾病进展的风险。结论：我们的研究结果表明，与其他类型的B细胞大细胞淋巴瘤相比，PML患者可能表现出对大剂量化疗的敏感性增加。这些发现，如果得到证实，可能会对PML患者的初始管理产生影响。(C)1998年，美国临床肿瘤学会。
Purpose: This study was performed to evaluate the outcome of high-dose chemotherapy and autologous transplantation in patients with diffuse B-cell large-cell lymphoma, and, specifically, to evaluate the impact of primary mediastinal localization on the outcome of high-dose chemotherapy.Patients and Methods: A retrospective review war performed of all patients with diffuse large B-cell lymphoma who underwent autologous marrow or peripheral-blood stem-cell transplantation at our institution between January 1986 and December 1995.Results: Ninety patients were identified, of whom 31 (34%) had a primary mediastinal B-cell large-cell lymphoma (PML). Cumulative probabilities of disease-free survival, overall survival, and disease progression are 40% (95% confidence interval [CI], 29 to 51), 42% (95% CI, 31 to 53), and 52% (95% CI, 40 to 64), respectively. By univariate analysis, low lactate dehydrogenase (LDH) level and low Ann Arbor stage at transplant were associated with improved survival and disease-free survival. There was a trend for improved disease-free survival and survival for patients with PML. Multivariate stepwise Cox regression analysis showed that LDH level, Ann Arbor stage, and primary mediastinal localization were independent favorable prognostic factors For disease-free survival and survival. LDH level and Ann Arbor stage were also predictive for the risk of disease progression.Conclusion: Our results indicate that patients with PML may display an increased susceptibility to high-dose chemotherapy compared with other types of B-cell large-cell lymphoma. These findings, if confirmed, may have implications for the initial management of patients with PML. (C) 1998 by American Society of Clinical Oncology.