Suheil Albert Atallah-Yunes, Matthew J Rees, Thomas E Witzig, Thomas M Habermann, Javier Munoz, Madiha Iqbal, Ellen D McPhail, Grzegorz S Nowakowski
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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 EFS on univariate (HR=0.54, 95%CI=0.31-0.97) and multivariable analysis adjusted for age, BCL translocation (BCL2 vs BCL6 vs both), IPI score and receipt of ASCT (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 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. 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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. 113 patients were identified; CODOX-M/IVAC-R (N=49) and DA-EPOCH-R (N=64). 80% (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 EFS on univariate (HR=0.54, 95%CI=0.31-0.97) and multivariable analysis adjusted for age, BCL translocation (BCL2 vs BCL6 vs both), IPI score and receipt of ASCT (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). 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引用次数: 0
摘要
尽管与R-CHOP相比,强化化疗免疫疗法对年轻的双击和三击淋巴瘤(DHL/THL)患者的生存并无益处,但该疗法仍被广泛应用。关于CODOX-M/IVAC-R应用效果良好的回顾性报告存在选择偏差,因为只有身体健康的年轻患者才能耐受这种疗法。我们进行了一项回顾性分析,研究在 60 岁或以下的 DHL/THL 患者中 CODOX-M/IVAC-R 和 DA-EPOCH-R 治疗效果的差异。共确定了 113 名患者;CODOX-M/IVAC-R(49 人)和 DA-EPOCH-R(64 人)。完成CODOX-M/IVAC-R治疗后,80%的患者(39/49)达到完全(CR),而完成DA-EPOCH-R治疗后,58%的患者(37/64)达到完全(CR)。CODOX-M/IVAC-R组和DA-EPOCH-R组的中位随访时间分别为5.3年和3.3年。CODOX-M/IVAC-R在单变量分析(HR=0.54,95%CI=0.31-0.97)和多变量分析(调整年龄、BCL易位(BCL2 vs BCL6 vs 两者)、IPI评分和接受ASCT)中显示出更优的EFS(aHR=0.52,95%CI=0.29-0.93);但对OS没有显著影响(aHR=0.92,95%CI=0.46-1.84)。CODOX-M/IVAC-R组的1年、2年和5年EFS分别为68.3%、64.1%和61.5%,而DA-EPOCH-R组分别为52.4%、48.9%和39.5%。33%(16/49)的CODOX-M/IVAC-R受试者和54%(35/64)的DA-EPOCH-R受试者出现原发性难治性疾病或复发,中位OS分别为10.3个月和33.7个月,这表明患有R/R疾病的CODOX-M/IVAC-R亚组的预后较差。DA-EPOCH-R组中有更多患者能够接受后续挽救疗法。两组中没有患者死于方案毒性,中枢神经系统复发率和治疗相关血液肿瘤发生率相似。
CODOX-M/IVAC-R versus DA-EPOCH-R in double hit/triple hit lymphoma patients aged 60 years or under.
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. 113 patients were identified; CODOX-M/IVAC-R (N=49) and DA-EPOCH-R (N=64). 80% (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 EFS on univariate (HR=0.54, 95%CI=0.31-0.97) and multivariable analysis adjusted for age, BCL translocation (BCL2 vs BCL6 vs both), IPI score and receipt of ASCT (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 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 CNS relapse and therapy related hematologic neoplasms were similar in both groups.
期刊介绍:
Haematologica is a journal that publishes articles within the broad field of hematology. It reports on novel findings in basic, clinical, and translational research.
Scope:
The scope of the journal includes reporting novel research results that:
Have a significant impact on understanding normal hematology or the development of hematological diseases.
Are likely to bring important changes to the diagnosis or treatment of hematological diseases.