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THE CLINICAL COURSE OF PATIENTS WITH FOLLICULAR LYMPHOMAIN THE RITUXIMAB ERA 美罗华时代滤泡性淋巴瘤患者的病程 这是在第13届瑞士卢加诺国际恶性淋巴瘤大会上发表的一篇论文摘要，作者来自英国BARTS癌症研究所血液－肿瘤科。 Introduction: The clinical course of patients with follicular lymphoma (FL) was lastdescribed in 1995, before novel agents were introduced into standard care. Theaim of this study was to describe the effect most recent therapeutic advanceshave had on the pattern of relapse in patients with FL. 介绍：关于滤泡性淋巴瘤患者的病程的描述上一次是在1995年，那时候一些新药还未被纳入标准治疗。本项研究的目的是揭示最新治疗上的进步对滤泡性淋巴瘤患者复发模式的影响。 Methods: Between 1997—the date when rituximab was introduced in ourinstitution—and 2012, 235 patients (female, 53%; median age: 57 years—range:24–89; stages III–IV: 68%) were diagnosed with grades 1–3a FL at StBartholomew's hospital and constituted the study group. We analysed theresponse and relapse rates and the duration of remission from best response, inaddition to the overall survival (OS). Survival analysis and duration ofremission were performed by the Kaplan–Meier method, and the Cox regressiontest was used to test for significant associations. 方法：在1997年（本研究所引入美罗华的日期）到2012年期间，在St Bartholomew's医院共有235例患者（女性53%；中位年龄57岁，III－IV期68%）被确诊为1-3a级滤泡性淋巴瘤因而被纳入研究范围。我们分析了应答率和复发率，以及总生存率和最佳应答后的缓解持续期。用Kaplan–Meier方法进行了生存分析和缓解持续时间的研究，并用COX回归测试法来检查主要的关联因素。 Results: One hundred and sixteen patients were managed expectantly at diagnosis,whereas the remainder received immediate treatment (28 CHOP ∓ rituximab, 55 chlorambucil ∓ rituximab;21 radiotherapy; 10 fludarabine based, 2 bendamustine based and 3 single-agentrituximab). Aftera median follow-up of 8 years (range: 1.0–17), 41 patients never requiredtreatment. High-dose therapy with autologous stem cell rescue (HDT-ASCR) wasperformed to consolidate response in 11 patients in first remission, in 19 atsecond remission and 1 in third remission. One hundred and thirty-sevenpatients received rituximab at some point as part of their treatment (91 aspart of the initial treatment and 46 as part of subsequent treatments), while98 have never received rituximab. The 5-year and 10-year OS and for the wholegroup were 82% (95% CI: 76–86) and 66% (95% CI: 58–72), respectively. Responserates, the median duration of remission from best response, the median survivalfrom best response and relapse rate are in the table below. 结果：116例患者在确诊后进行了观察，其余立即开始了治疗（28例CHOP＋／－美罗华；55例瘤可然＋／—美罗华；21例放疗；10例氟达拉滨联合化疗；2例苯达莫斯汀单药；3例美罗华单药）。在8年（1年-17年）中位随访期后，有41例患者从未需要治疗；11例患者在首次缓解后，19例在第二次缓解后，1例在第三次缓解后接受了高剂量化疗加自体干细胞挽救进行巩固；137例患者在某一个阶段接受了美罗华治疗（91例在初治阶段，46例在后续治疗阶段），98例从未接受美罗华治疗。全组病人5年和10年的生存率分别为82%和66%。应答率，最佳应答后中位缓解持续时间和复发率见下表。 Table 5. Responserate, duration of remission, relapse rate and survival for each event | | Number of patients treated 患者人数 | Patients treated with rituximab (%) 美罗华治疗％ | | Median duration of best response 中位缓解时间 | | Median survival from best response 中位生存率 | | | | | | | | | | | | | | | | | | | | | |
Conclusions: Incontrast with the previous description of the clinical course in patients withFL in the pre-rituximab era, we did not observe a progressive substantialshortening of the response duration and survival with each subsequent relapse.This demonstrates that the introduction of new therapeutic options impacts notonly on the outcome of patients but can also alter the clinical course of thedisease. 结论：与美罗华时代之前对滤泡性淋巴瘤患者病程的描述相比，我们没有观察到随着每一次复发缓解持续时间以及生存期的缩短。这证明新的治疗手段的引入不仅影响到了病人的转归，而且可以改变这种疾病的临床病程。
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