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Clinical characteristics and outcomes of extranodal stage I diffuse large B-cell lymphoma in the rituximab era.

利妥昔单抗时代结外I期弥漫性大b细胞淋巴瘤的临床特征和结局。

  • 影响因子:7.27
  • DOI:10.1182/blood.2020005112
  • 作者列表:"Bobillo S","Joffe E","Lavery JA","Sermer D","Ghione P","Noy A","Caron PC","Hamilton A","Hamlin PA","Horwitz SM","Kumar A","Matasar MJ","Moskowitz A","Owens CN","Palomba ML","Batlevi CL","Straus D","von Keudell G","Zelenetz AD","Yahalom J","Dogan A","Seshan VE","Younes A
  • 发表时间:2021-01-07
Abstract

:This retrospective study aimed to better define the characteristics and outcomes of extranodal stage I diffuse large B-cell lymphoma (DLBCL) in the rituximab era. Patients diagnosed with stage I DLBCL from 2001 to 2015 treated with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) or R-CHOP-like regimens with or without radiation (RT) were included. We identified 1955 patients with newly diagnosed DLBCL, of whom 341 had stage I and were eligible for this analysis. Extranodal presentation was observed in 224 (66%) patients, whereas 117 (34%) had nodal involvement. The most common extranodal sites were as follows: bone, 21%; stomach, 19%; testis, 9%; intestine, 8%; breast, 8%. Overall, 69% extranodal patients and 68% nodal patients received RT. Median follow-up was 5.5 years (interquartile range, 4.3-8.2). Ten-year overall survival (OS) and disease-free survival were 77% (95% confidence interval [CI], 67%-83%) and 77% (95% CI, 68%-85%). In the multivariable analyses, extranodal involvement was associated with worse OS (hazard ratio [HR], 3.44; 95% CI, 1.05-11.30) and progression-free survival (PFS; HR, 3.25; 95% CI, 1.08-9.72) compared with nodal involvement. Consolidation RT was associated with better OS (HR, 0.26; 95% CI, 0.12-0.49) and PFS (HR, 0.35; 95% CI, 0.18-0.69) in the extranodal population; however, the benefit was no longer observed in patients that were positron emission tomography (PET) negative at the end of immunochemotherapy. Relapses occurred usually late (median, 37 months), and the most common sites were the lymph nodes (31%) and the central nervous system (27%). Extranodal stage I DLBCL had a worse outcome than nodal stage 1 DLBCL. End of immunochemotherapy PET results may help select extranodal patients for consolidation RT.

摘要

: 这项回顾性研究旨在更好地确定利妥昔单抗时代结外I期弥漫性大b细胞淋巴瘤 (DLBCL) 的特征和结局。包括2001年至2015年诊断为I期DLBCL的患者,接受利妥昔单抗、环磷酰胺、多柔比星、长春新碱、泼尼松 (r-chop) 或r-chop样方案 (伴或不伴放疗 (RT)) 治疗。我们确定了1955例新诊断的DLBCL患者,其中341例为I期,符合该分析的条件.在224 (66%) 例患者中观察到结外表现,而117 (34%) 有淋巴结受累。最常见的结外部位如下: 骨,21%; 胃,19%; 睾丸,9%; 肠,8%; 乳腺,8%。总体上,69% 名结外患者和68% 名结外患者接受了RT。中位随访时间为5.5年 (四分位距,4.3-8.2).10年总生存率 (OS) 和无病生存率分别为77% (95% 可信区间 [CI],67%-83%) 和77% (95% CI,68%-85%)。在多变量分析中,与淋巴结受累相比,结外受累与较差的OS (风险比 [HR],3.44; 95% CI,1.05-11.30) 和无进展生存期 (PFS; HR,3.25; 95% CI,1.08-9.72) 相关。在结外人群中,巩固RT与更好的OS (HR,0.26; 95% CI,0.12-0.49) 和PFS (HR,0.35; 95% CI,0.18-0.69) 相关; 然而,在正电子发射断层扫描 (PET) 的患者中不再观察到益处。免疫化疗结束时阴性。复发通常发生在晚期 (中位数,37个月),最常见的部位是淋巴结 (31%) 和中枢神经系统 (27%)。结外I期DLBCL的预后比淋巴结1期DLBCL差。免疫化疗结束PET结果可能有助于选择结外患者进行巩固RT。

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