CODOX-M/IVAC-R 与 DA-EPOCH-R 在60岁及以下双突/三突淋巴瘤患者中的比较

CODOX-M/IVAC-R versus DA-EPOCH-R in double-hit/triple-hit lymphoma patients aged 60 years or under

HAEMATOLOGICA

影响因子:7.9

分区:医学1区 Top / 血液学2区

发表日期:2025 Feb 01

作者: Suheil Albert Atallah-Yunes, Matthew J Rees, Thomas E Witzig, Thomas M Habermann, Javier Munoz, Madiha Iqbal, Ellen D McPhail, Grzegorz S Nowakowski

DOI: 10.3324/haematol.2024.286168

摘要

尽管与 R-CHOP 相比，强化的化疗免疫方案在年轻双突和三突淋巴瘤（DHL/THL）患者中常被采用，但其未显示出明显的生存获益。关于应用 CODOX-M/IVAC-R 的有利回顾性报道存在选择偏差，因为只有身体状况良好的年轻患者才能耐受此治疗。我们进行了回顾性分析，旨在比较60岁及以下 DHL/THL 患者中 CODOX-M/IVAC-R 与 DA-EPOCH-R 的疗效差异。共识别出113例患者；其中CODOX-M/IVAC-R组49例，DA-EPOCH-R组64例。完成CODOX-M/IVAC-R后，80%（39/49）达成完全缓解（CR），而DA-EPOCH-R组为58%（37/64）。两组的中位随访时间分别为5.3年和3.3年。单变量分析（风险比[HR]=0.54，95%置信区间[CI]：0.31-0.97）及多变量调整分析（调整年龄、BCL易位（BCL2与BCL6及两者皆有）、国际预后指数评分和自体干细胞移植的接受情况，调整后HR[aHR]=0.52，95% CI：0.29-0.93）均显示CODOX-M/IVAC-R在无事件生存期（EFS）方面优于DA-EPOCH-R。然而，对总生存期（OS）没有显著影响（aHR=0.92，95% CI：0.46-1.84）。CODOX-M/IVAC-R组的1、2和5年EFS分别为68.3%、64.1%和61.5%，而DA-EPOCH-R组为52.4%、48.9%和39.5%。原发性难治或复发（R/R）疾病在CODOX-M/IVAC-R组为33%（16/49），在DA-EPOCH-R组为54%（35/64），中位OS分别为10.3个月和33.7个月，提示R/R疾病患者在CODOX-M/IVAC-R组预后较差。更多患者在DA-EPOCH-R组接受了后续救援治疗。无患者因方案毒性死亡，且两组的中枢神经系统复发率及治疗相关血液系统肿瘤发生率类似。

Abstract

Intensified chemoimmunotherapy regimens are often used in young patients with double-hit and triple-hit lymphoma (DHL/ THL) despite no survival benefit compared to R-CHOP. Favorable retrospective reports on the application of CODOX-M/IVAC-R are subject to selection bias as only young fit patients can tolerate this treatment. We conducted a retrospective analysis to investigate outcome differences between CODOX-M/IVAC-R and DA-EPOCH-R in DHL/THL patients aged 60 years or younger. One hundred and thirteen patients were identified; CODOX-M/IVAC-R (N=49) and DA-EPOCH-R (N=64). Eighty percent (39/49) achieved complete (CR) after completing CODOX-M/IVAC-R compared to 58% (37/64) with DA-EPOCH-R. The median follow-up was 5.3 years and 3.3 years for the CODOX-M/IVAC-R and DA-EPOCH-R group respectively. CODOX-M/IVAC-R demonstrated superior event-free survival (EFS) on univariate (hazard ratio [HR]=0.54, 95% confidence interval [CI]: 0.31-0.97) and multivariable analysis adjusted for age, BCL translocation (BCL2 vs. BCL6 vs. both), International Prognostic Index score and receipt of autologous stem cell transplant (adjusted HR [aHR]=0.52, 95% CI: 0.29-0.93); however there was no significant influence on OS (aHR=0.92, 95% CI: 0.46-1.84). The 1, 2 and 5 years EFS in the CODOX-M/IVAC-R group was 68.3%, 64.1% and 61.5%, respectively compared to 52.4%, 48.9% and 39.5%, respectively in the DA-EPOCH-R group. Primary refractory disease or relapse (R/R) occurred in 33% (16/49) of CODOX-M/IVAC-R and 54% (35/64) of DA-EPOCH-R recipients, and produced median OS of 10.3 months and 33.7 months, respectively, indicating poor outcomes in the CODOX-M/IVAC-R subgroup with R/R disease. More patients were able to receive subsequent salvage therapies in the DA-EPOCH-R group. No patients died of regimen toxicity and the rates of central nervous system relapse and therapy related hematologic neoplasms were similar in both groups.