Blood:采用R-CHOP治疗的原发性纵隔大B细胞淋巴瘤(PMBCL) 的预后

2020-07-12 QQY MedSci原创

PMBCL患者采用R-CHOP治疗,随后根据PET检查结果决定是否进行RT巩固治疗的预后较好,而且可减少64%的RT治疗。

利妥昔单抗的联合应用提高了原发性纵隔大B细胞淋巴瘤(PMBCL) 的治愈率。但主要疗法的类型和放疗(RT)的作用仍未完全明确。因此,本研究拟评估主要采用R-CHOP治疗的PMBCL患者的预后,以及治疗结束(EOT)时用 FDG-PET扫描来指导巩固RT的影响。

招募年满18岁的经R-化疗治疗的PMBCL患者。在2005年之前,临床上主要建议患者采用R-CHOP +RT治疗(RT时代)。从2005年开始,EOT PET被用于指导RT,只有PET阳性的患者接受RT治疗(PET时代)。

共筛选了159位患者,其中94%的患者采用R-CHOP治疗,44%的患者接受RT治疗(在RT时代,78%的患者接受RT治疗;在PET时代,28%的患者接受RT治疗)。整个队列的5年进展时间(TTP)和总体存活率(OS)分别是80%和89%,在整个治疗时代相似。总体上,10%的患者为难治性疾病。

113位患者接受EOT PET扫描:63%阴性、37%阳性。EOT PET扫描阴性和阳性患者的5年TTP分别为90% vs 71%,5年OS分别为97% vs 88%。对于接受Deauville(D)评分PET扫描的患者(103位),扫描结果为阴性患者(D1-D3,DX)的5年TTP为91%,D5的预后较D4的明显更差(5年TTP:33% vs 87%,p=0.0002)。

综上所述,R-CHOP治疗的PMBCL患者的预后较好,采用PET适应性方法可使大部分患者避免接受不必要的RT治疗。小部分患者为难治性,或可从替代疗法中获益。

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