“强度不够，移植来凑”不可取

橙色雨丝

On 5th May 2017, the Journal of Clinical Oncology published an article by Daniel J. Landsburg from the University of Pennsylvania, Philadelphia, USA, and colleagues reporting the results of their large multicenter analysis of the impact of front-line therapy and Autologous Stem Cell Transplant (autoSCT) on relapse and survival in patients with Double-Hit Lymphoma (DHL) who achieved First Complete Remission (CR1) after completion of first-line therapy with R-CHOP or intensive therapy.

Abstract:
Purpose: Patients with double-hit lymphoma (DHL) rarely achieve long-term survival following disease relapse. Some patients with DHL undergo consolidative autologous stem-cell transplantation (autoSCT) to reduce the risk of relapse, although the benefit of this treatment strategy is unclear.

Methods: Patients with DHL who achieved first complete remission following completion of front-line therapy with either rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or intensive front-line therapy, and deemed fit for autoSCT, were included. A landmark analysis was performed, with time zero defined as 3 months after completion of front-line therapy. Patients who experienced relapse before or who were not followed until that time were excluded.

Results: Relapse-free survival (RFS) and overall survival (OS) rates at 3 years were 80% and 87%, respectively, for all patients (n = 159). Three-year RFS and OS rates did not differ significantly for autoSCT (n = 62) versus non-autoSCT patients (n = 97), but 3-year RFS was inferior in patients who received R-CHOP compared with intensive therapy (56% v 88%; P = .002). Three-year RFS and OS did not differ significantly for patients in the R-CHOP or intensive therapy cohorts when analyzed by receipt of autoSCT. The median OS following relapse was 8.6 months.

Conclusion: In the largest reported series, to our knowledge, of patients with DHL to achieve first complete remission, consolidative autoSCT was not associated with improved 3-year RFS or OS. In addition, patients treated with R-CHOP experienced inferior 3-year RFS compared with those who received intensive front-line therapy. When considered in conjunction with reports of patients with newly diagnosed DHL, which demonstrate lower rates of disease response to R-CHOP compared with intensive front-line therapy, our findings further support the use of intensive front-line therapy for this patient population.

这是美国最近公布的一项大规模临床研究的结果，虽然针对的是双重打击淋巴瘤，但是对其它类型淋巴瘤应该也有一定借鉴意义。对于双打，国内外基本上在一线治疗缓解后都进行自体干细胞移植以降低复发率，因为一旦复发，长期生存的机会会非常小。但是，一线自体干细胞移植是否真的能够降低复发率？非常遗憾的是这项研究未能发现移植和未移植的患者在三年无复发率和总生存率上存在明显的统计学意义上的区别，但是却发现一线治疗采用的方案对预后有显著的影响，采用R-CHOP方案相对于采用DA-EPOCH-R或者HyperCVAD-R等强化方案来说明显在三年无复发率和总生存率上处于劣势。这项研究虽然还不至于起到改变临床实践的作用，也就是说一线自体干细胞移植目前应该还是双重打击淋巴瘤的默认选项，但是千万不要夸大其作用而忽视常规化疗强度对临床转归的影响。简单的总结：对于高侵袭性淋巴瘤，“强度不够，移植来凑”的做法不可取。

附上三年RFS的数据：

3-year RFS:

• For all pts = 80%
• In pts with de novo (n=139) and transformed indolent (n=20) disease = 78% vs. 94%; P = 0.18
• In pts with IPI score <3 (n=84) vs. ≥3 (n=71) = 75% vs. 87%; P = 0.38
• In pts who harbored BCL2 rearrangement = 79%; BCL6 rearrangement = 77%; BCL2/BCL6 rearrangement (triple-hit lymphoma) = 70%; MYC-IG translocation (n=35) = 77%
• Non-autoSCT and autoSCT pts in CR1 = 75% vs. 89%; P = 0.12
• Non-autoSCT (n=91) and autoSCT (n=48) pts with de novo disease = 74% vs. 88%; P = 0.15
• Differed significantly among pts treated with R-CHOP (n=35), DA-EPOCH-R (n=81), R-hyperCVAD (n=32), and R-CODOX-M/IVAC (n=11): 56% vs. 88% vs. 87% vs. 91%, respectively; P = 0.003
• In intensive front-line therapy cohort (n = 124; DA-EPOCH-R, R-hyperCVAD, and R-CODOX-M/IVAC) = 88%; P = 0.002 compared with R-CHOP
• For pts receiving R-CHOP: without autoSCT in CR1 (n=27) = 51%; with autoSCT (n=8) = 75%
• For pts receiving intensive therapy: without autoSCT in CR1 (n=70) = 86%; with autoSCT (n=54) = 91%
  

你们啊太简单

好大一坨生肉。。。

wang_wei1988

有大神翻译吗

加油哦

看不懂

无峰驼

雨丝新作！！！必然精品！！！不过你这全英文的就太不地道了。。。。。

晨光如水

认识这些可以过四级了

六日

好像是说没完全缓解的不移植。化疗不敏感的移植也没什么用

孩子啊

病人都不知道强度够吗？全凭医生

真诚天好

对移植确实存在异议。

c76de

的确一直对于移植存在着很多想法，因为我个人认为移植并不意味着提高100%的痊愈机会，其实也就是提高一些而已，而且也是因人而异。所以对于初始治疗我不明白为何国内的医生强调需要移植（滤泡类型）

qwertasd

我是纵膈弥漫大B，也让我们初始治疗移植了

开心麦咪

看来我们的治疗正确的

美好家园

c76de 发表于 2017-5-17 12:19
的确一直对于移植存在着很多想法，因为我个人认为移植并不意味着提高100%的痊愈机会，其实也就是提高一些而 ...

现在医生都是为了利益，不会考虑病人身体是否承受能力

林勤

任何一种医疗方案都是有风险的，雨丝大神之前的帖子里说过这一点，只是现在的医生只说了提高痊愈率，也没往下说风险了。移植也不是不会复发，三个月复发，八个月后复发，所以移植不是万能，也不是必选吧

大福娃

希望国内医生能多学习借鉴最新研究资料，哎，现状堪忧啊

百香果

一线方案应该再强些呗？

娜美丽

大神！我决定了 不做了 滤泡四期骨髓侵犯 做了自体也那么回事！还是顺其自然 维持治疗 用自身打败它！

期待康复

For all pts = 80%In pts with de novo (n=139) and transformed indolent (n=20) disease = 78% vs. 94%; P = 0.18I惰性转化的大b的rfs与原发大b没有统计学意义，但从百分比上看似乎还好点。

搞笑的袁乘三

原发纵隔HyperCVAD-R路过，打算cr后移植。。。

c76de

美好家园 发表于 2017-5-17 15:11
现在医生都是为了利益，不会考虑病人身体是否承受能力

是的，把这些定为标准流程，但是移植也要看年纪包括身体状况的