晚期弥漫性大B细胞淋巴瘤患者的6倍R-CHOP21与6X R-CHOP21+2 R的比较有效性
Comparative effectiveness of 6x R-CHOP21 versus 6x R-CHOP21 + 2 R for patients with advanced-stage diffuse large B-cell lymphoma
影响因子:11.60000
分区:医学1区 Top / 血液学1区 肿瘤学1区
发表日期:2024 Sep 12
作者:
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
摘要
晚期弥漫性大B细胞淋巴瘤（DLBCL）的一线治疗通常涉及6倍R-CHOP21或6X R-CHOP21，并具有另外两个Rituximab施用（6x R-Chop21+2 R）。在当代实践中，这种治疗选择可能受到临时PET扫描结果的指导。这项基于人群的全国研究研究了这些治疗方案的比较有效性，在临时宠物指导的治疗决策不是标准实践的时代。利用荷兰癌症注册中心，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6倍R-CHOP21（43％）或6X R-CHOP21+2 R（57％）。我们使用倾向得分来评估无事件生存（EFS）和总生存期（OS）的差异。在五年中，EFS（危险比为6倍R-CHOP21+2 R与6倍R-CHOP21 [HR] = 0.89; 95％置信区间[CI]，0.72-1.09）和OS（HR = 0.93; 95％CI，0.73-1.18）在两种方案之间都没有显着差异。 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%).总的来说，该分析表明EFS和两种处理之间的OS平均没有显着差异。但是，接受6倍R-CHOP21+2 R治疗的高危患者的潜在益处强调了对未来研究的需求。
Abstract
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.