滤泡性淋巴瘤国际预后指数2在利妥昔单克隆抗体维持治疗滤泡性淋巴瘤患者中的预后意义

Prognostic Significance of Follicular Lymphoma International Prognostic Index 2(FLIPI2) in Follicular Lymphoma Patients Treated with Rituximab Maintenance

目的:探讨滤泡性淋巴瘤国际预后指数2(FLIPI2)在滤泡性淋巴瘤(FL)中的预后意义,以期寻找更适合维持治疗的人群,为个体化治疗进行更深入的探索。方法:对2002年12月至2014年12月以利妥昔单克隆抗体联合环磷酰胺、多柔比星、长春新碱及泼尼松(R-CHOP)化疗方案治疗的140例初治FL患者进行回顾性分析。140例中122例经过治疗后获得缓解,其中56例接受2个月1次利妥昔单克隆抗体维持(RM),中位维持8次(RM组);66例不接受任何抗淋巴瘤药物治疗(non-RM组)。结果:RM组及non-RM组在年龄、性别、病理分级、Ann Arbor分期、FLIPI及FLIPI2评分等临床及病理特征方面均无显著性差异。RM组和non-RM组的2年无进展生存(PFS)分别为89.7%和77.6%(P=0.043),其2年总生存(OS)分别为100%和98.6%(P=0.131)。无论在整体队列、RM组或non-RM组中,FLIPI2均可将患者分为预后显著差异的3个危险组别(P<0.001)。亚组分析显示,FLIPI2低危及中危患者RM组较non-RM组的PFS显著提升;但在FLIPI2高危组中,RM与non-RM组的2年PFS率分别为55.6%和46.9%(P=0.920)。结论:经一线R-CHOP方案治疗缓解的FL患者,无论是否行RM,FLIPI2均对其预后判别具有重要意义。FLIPI2低危及中危患者均可以从RM治疗中获益,但是高危患者中RM治疗的意义仍值得进一步明确。

Objective： To investigate the prognostic significance of Follicular Lymphoma International Prognostic Index 2 （FLIPI2） in FL patients treated with rituximab maintenance. Methods： A tatol of 140 newly diagnosed FL patients who received Rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone （R-CHOP） chemotherapy in our department were retrospectively analyzed from December 2002 to December 2014. Among 140 patients with FL 122 patients achieved response, from them 56 patients received R maintenance （RM） every 2 months for median 8 times （ RM group） while the rest 66 patients did not receive further anti-lymphoma treatment （ non-RM group）. Results ： There was no statistical difference in age, sex, pathologic grading, staging, FLIPI or FLIPI2 between RM and non-RM groups. The 2 - year progression-free survival （ PFS ） of RM and non-RM groups were 89.7% and 77. 6% （P = 0. 043 ） while the 2 - year overall survival were 100% and 98.6% （P = 0. 131 ）. FLIPI2 is a significant prognostic model either in the total cohort, RM or non-RM groups （P 〈0.001 all）. In subgroup analysis, RaM was able to decrease disease progression in low and intermediate-risk group of FLIPI2, while the 2 - year PFS of RM and non-RM groups in high-risk group were similar （55. 6% vs 46. 9% ）（P=0. 920）. Conclusion： FL1PI2 presents robust prognostic significance either in RM or OBS patients, the patients in FLIPI2 low and intermediate-risk group may benefite from RM, but the role of RM in high-risk patients should be further to investigate.