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
英文原题:The clinical features, treatment, and prognostic factors for peripheral T-cell lymphomas: A single-institution analysis of 240 Chinese patients.
The clinical features, treatment, and prognostic factors for peripheral T-cell lymphomas: A single-institution analysis of 240 Chinese patients.
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目前大多数 PTCL 亚型的现有治疗生存结局仍不令人满意。
本研究旨在分析中国外周T细胞淋巴瘤(PTCL)患者(不包括自然杀伤/T细胞淋巴瘤[NKTCL])的临床特征、治疗、生存和预后因素。
回顾性分析本院2006年1月1日至2017年12月31日新诊断PTCL患者的数据,排除NKTCL患者。
共纳入240例患者。最常见亚型为非特指型PTCL(PTCL-NOS,42.5%),其次为血管免疫母细胞性T细胞淋巴瘤(AITL,21.3%)、ALK阴性间变性大细胞淋巴瘤(ALK-ALCL,16.7%)、ALK阳性ALCL(ALK⁺ALCL,10.8%)及其他亚型(8.8%)。中位随访81.1个月时,全体患者5年无进展生存期(PFS)和总生存期(OS)率分别为30.4%(95% CI 25.0%–37.0%)和48.8%(95% CI 42.6%–55.7%)。多变量分析显示,未接受巩固性自体干细胞移植(ASCT)及一线化疗后未达到完全缓解,仍是PFS和OS较差的独立预后因素。此外,骨髓受累和血清白蛋白水平是PFS的独立因素,东部肿瘤协作组体能状态评分≥2则显著预测OS较差。与PTCL-NOS相比,ALK⁺ALCL和ALK-ALCL的PFS和OS显著更好。
目前治疗大多数PTCL亚型的生存结局仍不理想。需开展前瞻性随机研究以确定巩固性ASCT在PTCL中的价值,并探索新型治疗方法。
Data on patients with newly diagnosed PTCLs between January 1, 2006 and December 31, 2017 at our hospital were retrospectively reviewed. Patients with NKTCL were excluded.
A total of 240 patients were included. PTCL, not otherwise specified (PTCL-NOS), was the most frequent subtype (42.5%), followed by angioimmunoblastic T-cell lymphoma (AITL) (21.3%), anaplastic lymphoma kinase (ALK)-negative anaplastic large-cell lymphoma (ALK-ALCL) (16.7%), ALK-positive ALCL (ALK+ALCL) (10.8%) and others (8.8%). With a median follow-up of 81.1 months, the 5-year progression-free survival (PFS) and overall survival (OS) rates for all patients were 30.4% (95% CI 25.0%-37.0%) and 48.8% (95% CI 42.6%-55.7%), respectively. On multivariate analysis, no consolidative autologous stem cell transplantation (ASCT) and not achieving complete response after first-line chemotherapy retained independently prognostic value for inferior PFS and OS. Besides, bone marrow involvement and serum albumin level were independent factors for PFS, and Eastern Cooperative Oncology Group performance status ≥2 was significantly predictive of inferior OS. Compared with PTCL-NOS, significantly superior PFS and OS were observed for ALK+ALCL and ALK-ALCL.
The survival outcomes with current treatment for most PTCL subtypes are still unsatisfactory. Prospective randomized studies are needed to establish the value of consolidative ASCT in PTCL, and novel therapeutic approaches should be explored.
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