晚期弥漫性大B细胞淋巴瘤患者中6次R-CHOP21与6次R-CHOP21+2R的疗效比较

Comparative effectiveness of 6x R-CHOP21 versus 6x R-CHOP21 + 2 R for patients with advanced-stage diffuse large B-cell lymphoma

Blood Cancer Journal

影响因子:11.6

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

DOI: 10.1038/s41408-024-01137-0

摘要

晚期弥漫性大B细胞淋巴瘤（DLBCL）的一线治疗通常包括6次R-CHOP21或在此基础上加两次利妥昔单抗（6x R-CHOP21 + 2 R）。在当代实践中，治疗选择可能受到中期PET扫描结果的指导。本全国性人群基础研究利用荷兰癌症登记系统，识别了2014-2018年间诊断的1577例成人晚期DLBCL患者，其中有43%接受了6x R-CHOP21，57%接受了6x R-CHOP21 + 2 R。我们采用倾向评分评估两组的无事件生存期（EFS）和总生存期（OS）差异。五年时，6x R-CHOP21 + 2 R组的EFS（HR=0.89，95% CI：0.72-1.09）和OS（HR=0.93，95% CI：0.73-1.18）与6x R-CHOP21组无统计学显著差异。在根据国际预后指数（IPI）进行的风险分层分析中，高IPI患者（评分4-5）从6x R-CHOP21 + 2 R中获益最大（五年绝对风险差异：EFS 16.8%，95% CI：-0.4%-34.1%；OS 12.1%，95% CI：-5.4%-29.6%）。总体而言，分析显示两种治疗在平均水平上EFS和OS无显著差异，但高风险患者使用6x R-CHOP21 + 2 R的潜在获益提示未来需进一步研究。

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.