套细胞淋巴瘤患者维持治疗方案的多中心回顾性研究

A multicenter retrospective study discussion on maintenance treatment strategies for mantle cell lymphoma

目的探索套细胞淋巴瘤(MCL)患者不同维持治疗策略的生存差异。方法收集1999年4月至2019年12月多家中心诊治的693例MCL患者临床资料,其中维持治疗组309例,总结不同维持治疗组患者的特征,进行Kaplan-Meier生存及预后分析。结果本组研究总体3年和5年无进展生存(PFS)率分别为(73.5±2.9)%和(53.6±4.3)%,3年和5年总生存(OS)率分别为(94.2±1.5)%和(82.7±3.2)%。不同维持治疗策略组患者临床特征基本一致,利妥昔单抗组、来那度胺组、布鲁顿酪氨酸激酶抑制剂(BTKi)组、双药治疗组,3年PFS率分别为(70.4±4.1)%、(69.1±7.6)%、(86.9±5.0)%和(80.4±5.1)%,3年OS率分别为(92.9±2.4)%、(97.3±2.7)%、(97.9±2.1)%和(95.3±2.7)%,差异无统计学意义(P=0.632、0.313)。多因素生存分析显示MCL国际预后指数(MIPI)高危组、维持治疗前完全缓解是PFS的独立危险因素;MIPI高危组、高剂量阿糖胞苷、治疗线数、早期疾病进展(POD24)为OS独立危险因素。结论通过比较MCL的不同维持治疗策略,初步显示BTKi在维持治疗中有获益趋势,同时患者危险分层及维持治疗前缓解状态是影响疾病进展的重要因素。

Objective:This study aims to explore the survival advantages of different maintenance strategies for MCL.Methods:Clinical data of 693 newly diagnosed MCL patients in multi-centers admitted from April 1999 to December 2019 were collected.309 cases received maintenance treatment.The characteristics of patients in different maintenance treatment groups were summarized and Kaplan-Meier survival and prognosis analysis were conducted.Results:The overall 3-year and 5-year progression-free survival(PFS)rates were(73.5±2.9)%and(53.6±4.3)%,respectively.The 3-year and 5-year overall survival(OS)rates were(94.2±1.5)%and(82.7±3.2)%,respectively.The clinical features of different maintenance treatment groups were generally consistent.The 3-year PFS rates of rituximab maintenance,lenalidomide maintenance,BTK inhibitor maintenance and dual-drug maintenance were(70.4±4.1)%,(69.1±7.6)%,(86.9±5.0)%,and(80.4±5.1)%,respectively.Corresponding 3-year OS rates were(92.9±2.4)%,(97.3±2.7)%,(97.9±2.1)%,and(95.3±2.7)%,respectively.There were no significant difference in different groups(P=0.632,0.313).Survival analysis identified the MCL International Prognostic Index(MIPI)high-risk group and achieving complete remission before maintenance treatment as independent risk factors for PFS.The MIPI high-risk group,high-dose cytarabine application,treatment lines,and early disease progression(POD24)emerged as independent risk factors for OS.Conclusion:Comparing the different maintenance strategies of MCL,the result showed that BTK inhibitors(BTKi)maintenance demonstrated preliminary advantages in survival.Meanwhile,high-risk group according to MIPI and incomplete remission before maintenance treatment were significant factors related to disease progression.