[利妥昔单抗联合强化免疫化疗治疗散发性成人伯基特淋巴瘤:疗效及预后分析]。

Q3 Medicine
C M Dong, H S Zou, W Zhang, W Liu, Y Wang, H M Liu, T Xie, H Li, Q Wang, W Y Huang, S H Yi, G An, L G Qiu, D H Zou
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Extranodal invasion was present in 80% of the patients, with involvement of the bone marrow in 53.3% and central nervous system in 10.0%. The Ann Arbor stage was Ⅲ and Ⅳ in 86.7%. According to the number of Burkitt Lymphoma International Prognostic Index (BL-IPI) risk factors, patients were classified as low risk (0) in 20.0%, intermediate risk (1) in 43.3%, and high risk (≥2) in 36.7%. All patients were treated with an induction regimen of rituximab combined with intensive chemotherapy, with objective and complete response rates of 80.0% and 76.7%, respectively. The median follow-up was 49 months (6-153 months), and the 5-year progression-free survival (PFS) and overall survival (OS) rates were both (76.7±7.7) %. All patients with limited stage (<i>n</i>=4) achieved continuous complete remission (CCR). Patients who had high risk, advanced stage sensitive to induction therapy (<i>n</i>=10) sequentially received first-line autologous hematopoietic stem cell transplantation (auto-HSCT) as consolidation therapy; 9 patients achieved CCR, whereas 1 patient with central nervous system invasion developed early disease progression and died. The BL-IPI low, intermediate, and high risk groups had respective 5-year PFS rates of (83.3±15.2) %, 100.0%, and (45.5±15.0) % (<i>P</i>=0.0069) and OS rates of (83.3±15.2) %, 100.0%, and (45.5±15.0) % (<i>P</i>=0.0075). The main adverse effects of induction therapy were myelosuppression and secondary infections, which were effectively managed by appropriate symptomatic treatment. 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引用次数: 0

摘要

目的:探讨利妥昔单抗联合强化化疗治疗散发性成人伯基特淋巴瘤(BL)的疗效及影响预后的因素。方法:回顾性分析2011年7月至2023年2月在血科医院新诊断的30例BL患者的临床和生存资料。生存分析采用Kaplan-Meier法,预后因素单因素分析采用log-rank检验。结果:30例患者中位年龄为43岁(24 ~ 66岁),男女比例为3:2。80%的患者存在结外侵犯,53.3%的患者累及骨髓,10.0%的患者累及中枢神经系统。安娜堡期分别为Ⅲ和Ⅳ,占86.7%。根据伯基特淋巴瘤国际预后指数(BL-IPI)危险因素的数量,20.0%的患者分为低危(0)级,43.3%的患者分为中危(1)级,36.7%的患者分为高危(≥2)级。所有患者均采用利妥昔单抗诱导方案联合强化化疗,客观缓解率为80.0%,完全缓解率为76.7%。中位随访时间为49个月(6-153个月),5年无进展生存期(PFS)和总生存期(OS)均为(76.7±7.7)%。所有有限期患者(n=4)均达到持续完全缓解(CCR)。高风险、对诱导治疗敏感的晚期患者(n=10)依次接受一线自体造血干细胞移植(auto-HSCT)作为巩固治疗;9例患者获得CCR, 1例中枢神经系统侵犯患者出现早期疾病进展并死亡。BL-IPI低、中、高风险组5年PFS分别为(83.3±15.2)%、100.0%和(45.5±15.0)% (P=0.0069), OS分别为(83.3±15.2)%、100.0%和(45.5±15.0)% (P=0.0075)。诱导治疗的主要不良反应是骨髓抑制和继发感染,通过适当的对症治疗可有效控制。单因素分析显示,较差的PFS与BL-IPI评分≥2相关(HR=4.90, 95% CI 1.02 ~ 23.45, P=0.0329);结外浸润≥2个部位(HR=12.62, 95% CI 2.59 ~ 61.62, P=0.0021);结论:强化免疫化疗方案对成年高侵袭性BL患者有效且耐受性良好,对有限期患者疗效理想,而对高危BL- ipi患者预后不理想。序贯一线自体造血干细胞移植巩固治疗可进一步改善对诱导治疗敏感的高风险晚期疾病患者的预后。BL- ipi评分≥2,结外浸润≥2个部位,诱导治疗后未能达到CR1是成年BL患者的不良预后因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Rituximab combined with intensive immunochemotherapy for sporadic adult Burkitt lymphoma: efficacy and prognosis analyse].

Objective: To explore the therapeutic efficacy and prognostic factors of combined rituximab and intensive chemotherapy for sporadic adult Burkitt lymphoma (BL) . Methods: This retrospective study examined the clinical and survival data of 30 patients newly diagnosed with BL between July 2011 and February 2023 at the Blood Diseases Hospital. Kaplan-Meier method was used for survival analysis, and the log-rank test was used for univariate analysis of prognostic factors. Results: The median age of the 30 patients was 43 years (24 - 66 years), and the male to female ratio was 3: 2. Extranodal invasion was present in 80% of the patients, with involvement of the bone marrow in 53.3% and central nervous system in 10.0%. The Ann Arbor stage was Ⅲ and Ⅳ in 86.7%. According to the number of Burkitt Lymphoma International Prognostic Index (BL-IPI) risk factors, patients were classified as low risk (0) in 20.0%, intermediate risk (1) in 43.3%, and high risk (≥2) in 36.7%. All patients were treated with an induction regimen of rituximab combined with intensive chemotherapy, with objective and complete response rates of 80.0% and 76.7%, respectively. The median follow-up was 49 months (6-153 months), and the 5-year progression-free survival (PFS) and overall survival (OS) rates were both (76.7±7.7) %. All patients with limited stage (n=4) achieved continuous complete remission (CCR). Patients who had high risk, advanced stage sensitive to induction therapy (n=10) sequentially received first-line autologous hematopoietic stem cell transplantation (auto-HSCT) as consolidation therapy; 9 patients achieved CCR, whereas 1 patient with central nervous system invasion developed early disease progression and died. The BL-IPI low, intermediate, and high risk groups had respective 5-year PFS rates of (83.3±15.2) %, 100.0%, and (45.5±15.0) % (P=0.0069) and OS rates of (83.3±15.2) %, 100.0%, and (45.5±15.0) % (P=0.0075). The main adverse effects of induction therapy were myelosuppression and secondary infections, which were effectively managed by appropriate symptomatic treatment. Univariate analysis demonstrated that worse PFS was associated with BL-IPI score ≥2 (HR=4.90, 95% CI 1.02-23.45, P=0.0329) ; extranodal invasion at ≥2 sites (HR=12.62, 95% CI 2.59-61.62, P=0.0021) ; and failure to achieve first complete response (CR1) after induction therapy (HR=31.86, 95% CI 4.19-242.20, P<0.0001) . Conclusions: Intensive immunochemotherapy regimens were effective and well-tolerated by adult patients with highly aggressive BL. Treatment efficacy was ideal in patients with limited-stage disease, whereas prognosis was unsatisfactory in patients with high-risk BL-IPI. Sequential first-line auto-HSCT consolidation therapy may further improve outcomes in patients with high-risk advanced-stage disease who are sensitive to induction therapy. BL-IPI score ≥2, extranodal invasion at ≥2 sites, and failure to achieve CR1 after induction therapy were adverse prognostic factors in adult patients with BL.

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