CODOX-M/IVAC-R与DA-EPOCH-R在60岁以下的双重打击/三次打击淋巴瘤患者中

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:7.90000

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

摘要

尽管与R-CHOP相比，尽管没有生存益处，但经常将加强的化学免疫疗法治疗方法用于双重打击和三局淋巴瘤（DHL/ THL）的年轻患者。关于CODOX-M/IVAC-R的应用的有利回顾性报告受到选择偏见，因为只有年轻的患者才能忍受这种治疗方法。我们进行了回顾性分析，以研究60岁以下的DHL/THL患者的Codox-M/IVAC-R和DA-EPOCH-R之间的结果差异。确定了13名患者； Codox-M/IVAC-R（n = 49）和da-epoch-r（n = 64）。完成CODOX-M/IVAC-R后，达到了80％（39/49），而DA-Epoch-R则为58％（37/64）。 CODOX-M/IVAC-R和DA-EPOCH-R组的中位随访分别为5。3年和3。3年。 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）;但是，对OS没有显着影响（AHR = 0.92，95％CI：0.46-1.84）。在DA-Epoch-R组中，Codox-M/IVAC-R组中的1、2和5年EFS分别为68.3％，64.1％和61.5％，分别为52.4％，48.9％和39.5％。原发性难治性疾病或复发（R/R）发生在Codox-M/IVAC-R的33％（16/49）中，DA-EPOCH-R受益者的54％（35/64）出现，分别产生了10.3个月和33.7个月的OS，表明CODOX-M/IVAC-M/IVAC-M/IVAC-M/IVAC-M/IVAC-R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/R/r疾病。越来越多的患者能够在DA-EPOCH-R组中接受随后的打捞疗法。在两组中，没有患者死于治疗毒性，中枢神经系统复发和相关的血液学肿瘤的发生率相似。

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.