晚期弥漫大 B 细胞淋巴瘤患者使用 6 倍 R-CHOP21 与 6 倍 R-CHOP21 + 2 R 的疗效比较

IF 12.9 1区 医学 Q1 HEMATOLOGY Blood Cancer Journal Pub Date : 2024-09-12 DOI:10.1038/s41408-024-01137-0
Carolien C. H. M. Maas, David van Klaveren, Müjde Durmaz, Otto Visser, Djamila E. Issa, Eduardus F. M. Posthuma, Josée M. Zijlstra, Martine E. D. Chamuleau, Pieternella J. Lugtenburg, Marie José Kersten, Avinash G. Dinmohamed
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引用次数: 0

摘要

晚期弥漫大 B 细胞淋巴瘤(DLBCL)的一线治疗通常包括 6 次 R-CHOP21 或 6 次 R-CHOP21 加两次利妥昔单抗给药(6 次 R-CHOP21 + 2 次 R)。在当代实践中,这种治疗选择可能会以中期 PET 扫描结果为指导。这项基于人群的全国性研究调查了这些治疗方案的比较效果,因为在那个时代,中期 PET 指导治疗决策还不是标准做法。利用荷兰癌症登记处,我们确定了 2014-2018 年间诊断为晚期 DLBCL 的 1577 名成年患者,他们完成了 6x R-CHOP21(43%)或 6x R-CHOP21 + 2 R(57%)。我们使用倾向评分来评估无事件生存期(EFS)和总生存期(OS)的差异。五年后,两种方案的无事件生存期(6 倍 R-CHOP21 + 2 R 与 6 倍 R-CHOP21 的危险比 [HR] = 0.89;95% 置信区间 [CI],0.72-1.09)和总生存期(HR = 0.93;95% CI,0.73-1.18)无显著差异。在根据国际预后指数(IPI)进行的探索性风险分层分析中,高 IPI 患者(即评分为 4-5 分)从 6x R-CHOP21 + 2 R 中获益最多(5 年 EFS 绝对风险差异 = 16.8%;95% CI,-0.4%-34.1% 和 OS = 12.1%;95% CI,-5.4-29.6%)。总之,这项分析表明,两种治疗方法的平均 EFS 和 OS 没有显著差异。然而,使用 6x R-CHOP21 + 2 R 治疗高风险患者的潜在益处强调了未来研究的必要性。
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Comparative effectiveness of 6x R-CHOP21 versus 6x R-CHOP21 + 2 R for patients with advanced-stage diffuse large B-cell lymphoma

First-line treatment for advanced-stage diffuse large B-cell lymphoma (DLBCL) typically involves 6x R-CHOP21 or 6x R-CHOP21 with two additional rituximab administrations (6x R-CHOP21 + 2 R). In contemporary practice, this treatment choice might be guided by interim PET scan results. This nationwide, population-based study investigates the comparative effectiveness of these treatment regimens in an era where interim PET-guided treatment decisions were not standard practice. Utilizing the Netherlands Cancer Registry, we identified 1577 adult patients diagnosed with advanced-stage DLBCL between 2014–2018 who completed either 6x R-CHOP21 (43%) or 6x R-CHOP21 + 2 R (57%). We used propensity scores to assess differences in event-free survival (EFS) and overall survival (OS). At five years, EFS (hazard ratio of 6x R-CHOP21 + 2 R versus 6x R-CHOP21 [HR] = 0.89; 95% confidence interval [CI], 0.72–1.09) and OS (HR = 0.93; 95% CI, 0.73–1.18) were not significantly different between both regimens. In exploratory risk-stratified analysis according to the International Prognostic Index (IPI), high-IPI patients (i.e., scores of 4-5) benefit most from 6x R-CHOP21 + 2 R (5-year absolute risk difference of EFS = 16.8%; 95% CI, −0.4%−34.1% and OS = 12.1%; 95% CI, −5.4–29.6%). Collectively, this analysis reveals no significant differences on average in EFS and OS between the two treatments. However, the potential benefits for high-risk patients treated with 6x R-CHOP21 + 2 R underscore the need for future research.

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来源期刊
CiteScore
16.70
自引率
2.30%
发文量
153
审稿时长
>12 weeks
期刊介绍: Blood Cancer Journal is dedicated to publishing high-quality articles related to hematologic malignancies and related disorders. The journal welcomes submissions of original research, reviews, guidelines, and letters that are deemed to have a significant impact in the field. While the journal covers a wide range of topics, it particularly focuses on areas such as: Preclinical studies of new compounds, especially those that provide mechanistic insights Clinical trials and observations Reviews related to new drugs and current management of hematologic malignancies Novel observations related to new mutations, molecular pathways, and tumor genomics Blood Cancer Journal offers a forum for expedited publication of novel observations regarding new mutations or altered pathways.
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