一线RCHOP方案治疗不同组织学亚型滤泡性淋巴瘤3级患者的临床疗效

Clinical efficiency of frontline RCHOP regimen in treatment of follicular lymphoma grade 3 patients with different histological subtypes

目的:探讨一线RCHOP方案治疗不同组织学亚型滤泡性淋巴瘤(follicular lymphoma, FL)3级患者患者的临床疗效。方法:回顾性分析2009年1月至2019年12月复旦大学附属中山医院收治的初诊并予一线RCHOP方案治疗的61例FL 3级患者的临床资料。患者分为FL 3A级组(n=42)和侵袭性FL组(n=19),侵袭性FL组包括3A级合并3B级2例、3B级8例和FL 3级伴弥漫大B细胞淋巴瘤成分9例。结果:两组患者性别、年龄、β;微球蛋白水平、乳酸脱氢酶水平、AnnArbor分期、B组症状、骨髓受累等差异均无统计学意义。中位随访时间为40.2个月。2组患者的3年总生存(OS)率分别为97.1%、81.9%,差异有统计学意义(P=0.041);3年无进展生存(PFS)率分别为69.1%、71.1%(P=0.546)。侵袭性FL组患者2年后出现PFS平台期。结论:一线RCHOP方案治疗FL 3A级患者3年总生存率优于侵袭性FL,但两者的PFS差异无统计学意义,侵袭性FL患者治疗2年后出现PFS平台期。

Objective: To explore the clinical features and outcomes of follicular lymphoma(FL) grade 3 treated with frontline RCHOP regimen.Methods: 61 FL grade 3 patients treated with frontline RCHOP regimen between January 2009 and December 2019 were retrospectively analyzed. We divided them into FL grade 3 A(n=42) and aggressive FL(n=19). Aggressive FL included grade 3 A with an additional 3 B component(n=2), grade 3 B(n=8), and grade 3 with areas of diffuse large B cell lymphoma(n=9).Results: The baseline characteristics, including gender, age, serum β;microglobulin and lactate dehydrogenase levels, Ann Arbor stage, B symptom and bone marrow involvement were similar between FL grade 3 A and aggressive FL. After a median follow-up period of 40.2 months, the 3-year overall survival(OS) rate was 97.1% in FL grade 3 A and 81.9% in aggressive FL,(P= 0.041). The 3-year progression free survival(PFS) rate was 69.1% and 71.1%, respectively,(P= 0.546). Patients of aggressive FL reached a plateau in the PFS curve after 2 years.Conclusions: The 3-year OS survival rate of the frontline RCHOP regimen in the treatment of FL3 A patients was better than that of aggressive FL, but the PFS difference between the two was not statistically significant. PFS plateau appears after 2 years of treatment in aggressive FL patients.