Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R
Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R
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DOI：
10.1111/bjh.14951
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发表时间：
2017-12-01
影响因子：
6.5
通讯作者：
Leonard, John P.
中科院分区：
文献类型：
--
作者：
Giulino-Roth, Lisa;O'Donohue, Tara;Leonard, John P.
剂量调整EPOCH（依托泊苷、阿霉素、环磷酰胺、新碱、泼尼松）化疗和利妥昔单抗（DA-EPOCH-R）治疗已成为许多机构治疗原发性纵间隔b细胞淋巴瘤（PMBCL）的标准，尽管在多中心环境下的数据有限。我们报告了一项大型、多中心的回顾性分析，对儿童和成人PMBCL患者进行DA-EPOCH-R治疗，以表征结果并评估预后因素。我们评估了来自24个学术中心的156例经DA-EPOCH-R治疗的PMBCL患者，包括38名儿童和118名成人。所有患者均接受至少一个周期的DA-EPOCH-R治疗。14.9%的患者接受放射治疗。中位随访22.6个月，估计3年无事件生存率（EFS）为85.9%[95%置信区间（CI） 80.3-91.5]，总生存率为95.4% （95% CI 91.8-99.0）。结果在儿科和成人患者之间没有统计学差异。28.2%的患者报告了血栓性并发症，在儿科患者中更为常见（45.9%比22.9%,P = 0.011）。75%的患者在DA-EPOCH-R结束时进行了阴性的氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）扫描，定义为多维尔评分1-3。治疗结束时FDG-PET阴性与EFS改善相关（95.4% vs. 54.9%, P < 0.001）。我们的数据支持使用DA-EPOCH-R治疗儿童和成人PMBCL。治疗结束时FDG-PET扫描阳性的患者预后较差。
Treatment with dose-adjusted EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone) chemotherapy and rituximab (DA-EPOCH-R) has become the standard of care for primary mediastinal B-cell lymphoma (PMBCL) at many institutions despite limited data in the multi-centre setting. We report a large, multi-centre retrospective analysis of children and adults with PMBCL treated with DA-EPOCH-R to characterize outcomes and evaluate prognostic factors. We assessed 156 patients with PMBCL treated with DA-EPOCH-R across 24 academic centres, including 38 children and 118 adults. All patients received at least one cycle of DA-EPOCH-R. Radiation therapy was administered in 14.9% of patients. With median follow-up of 22.6 months, the estimated 3-year event-free survival (EFS) was 85.9% [95% confidence interval (CI) 80.3-91.5] and overall survival was 95.4% (95% CI 91.8-99.0). Outcomes were not statistically different between paediatric and adult patients. Thrombotic complications were reported in 28.2% of patients and were more common in paediatric patients (45.9% vs. 22.9%, P = 0.011). Seventy-five per cent of patients had a negative fluorodeoxyglucose positron emission tomography (FDG-PET) scan at the completion of DA-EPOCH-R, defined as Deauville score 1-3. Negative FDG-PET at end-of-therapy was associated with improved EFS (95.4% vs. 54.9%, P < 0.001). Our data support the use of DA-EPOCH-R for the treatment of PMBCL in children and adults. Patients with a positive end-of-therapy FDG-PET scan have an inferior outcome.