不适合移植的大 B 细胞淋巴瘤二线使用 axicabtagene ciloleucel：ALYCANTE 最终分析
Second-line axicabtagene ciloleucel in large B-cell lymphoma ineligible for transplantation: ALYCANTE final analysis.
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
结外自然杀伤/T 细胞淋巴瘤的长期结局及中枢神经系统复发
英文原题：Long-term outcomes and central nervous system relapse in extranodal natural killer/T-cell lymphoma.
查看英文原题
Long-term outcomes and central nervous system relapse in extranodal natural killer/T-cell lymphoma.
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中文摘要
为阐明结外NK/T细胞淋巴瘤鼻型（ENKTL）患者接受非蒽环类药物治疗的长期结局及中枢神经系统（CNS）事件，一项日本全国性回顾性研究更新并分析了2000年至2013年间诊断的313例ENKTL患者的临床数据。在中位随访8.4年时，140例接受放疗-地塞米松、依托泊苷、异环磷酰胺和卡铂（RT-DeVIC）治疗的局限性ENKTL患者中，5年总生存期（OS）率和无进展生存期（PFS）率分别为71%和64%。9例（6.4%）患者发生了第二恶性肿瘤。在155例接受RT-DeVIC治疗的局限性ENKTL患者中，10例（6.5%）发生了CNS复发（中位时间为诊断后12.8个月）。其中5例的事件局限于CNS。10例发生CNS复发的患者中有9例在CNS复发后1年内死亡。
多因素分析确定牙龈受累（风险比[HR]，54.35；95%置信区间[CI]，8.60-343.35）和鼻旁窦受累（HR，7.42；95% CI，1.78-30.89）为CNS复发的独立危险因素。在80例晚期ENKTL患者中，18例接受了类固醇（地塞米松）、甲氨蝶呤、异环磷酰胺、L-天冬酰胺酶和依托泊苷（SMILE）化疗作为一线治疗。接受SMILE作为一线治疗的患者OS倾向于优于未接受者（p = 0.071）。6例（7.5%）晚期ENKTL患者发生了孤立性CNS复发（中位时间为诊断后2.6个月），并在复发后4个月内死亡。晚期ENKTL患者中未记录到第二恶性肿瘤。在整个队列中，首次复发或进展后的中位OS为4.6个月。12例在PFS事件后存活5年的患者，在末次随访时均无病生存期。其中，11例（92%）接受了造血干细胞移植。
我们的8年随访揭示了RT-DeVIC和SMILE的长期疗效和安全性。CNS复发风险是晚期ENKTL的一个重要考量因素。
展开英文摘要原文
To elucidate the long-term outcomes of non-anthracycline-containing therapies and central nervous system (CNS) events in patients with extranodal NK/T-cell lymphoma, nasal type (ENKTL), the clinical data of 313 patients with ENKTL diagnosed between 2000 and 2013 in a nationwide retrospective study in Japan were updated and analyzed. At a median follow-up of 8. 4 years, the 5-year overall survival (OS) and progression-free survival (PFS) were 71% and 64%, respectively, in 140 localized ENKTL patients who received radiotherapy-dexamethasone, etoposide, ifosfamide, and carboplatin (RT-DeVIC) in clinical practice. Nine (6. 4%) patients experienced second malignancies. In 155 localized ENKTL patients treated with RT-DeVIC, 10 (6. 5%) experienced CNS relapse (median, 12. 8 months after diagnosis). In five of them, the events were confined to the CNS. Nine of the 10 patients who experienced CNS relapse died within 1 year after CNS relapse.
Multivariate analysis identified gingival (hazard ratio [HR], 54. 35; 95% confidence interval [CI], 8. 60-343. 35) and paranasal involvement (HR, 7. 42; 95% CI, 1. 78-30. 89) as independent risk factors for CNS relapse. In 80 advanced ENKTL patients, 18 received steroid (dexamethasone), methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) chemotherapy as first-line treatment. Patients who received SMILE as their first-line treatment tended to have better OS than those who did not (p = 0.
071). Six (7. 5%) advanced ENKTL patients experienced isolated CNS relapse (median, 2. 6 months after diagnosis) and died within 4 months of relapse. No second malignancies were documented in advanced ENKTL patients. In the entire cohort, the median OS after first relapse or progression was 4. 6 months. 12 patients who survived 5 years after PFS events were disease-free at the last follow-up. Of those, 11 (92%) underwent hematopoietic stem cell transplantation.
Our 8-year follow-up revealed the long-term efficacy and safety of RT-DeVIC and SMILE. The risk of CNS relapse is an important consideration in advanced ENKTL.
论文信息
- 作者
- Miyazaki K、Suzuki R、Oguchi M、Taguchi S、Amaki J、Maeda T、Kubota N、Maruyama D
- 单位
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan.Japan
- 期刊
- Hematological oncology2022 Oct
- 原文标识
- PubMed 35142384 · DOI 10.1002/hon.2977