文章：

利妥昔单抗时代初诊后观察的滤泡性淋巴瘤患者首个十年内的治疗启动模式

Patterns of therapy initiation during the first decade for patients with follicular lymphoma who were observed at diagnosis in the rituximab era

原文发布日期：2021-07-17

DOI: 10.1038/s41408-021-00525-0

类型: Article

开放获取: 是

英文摘要：

Immediate treatment for asymptomatic, low-tumor burden follicular lymphoma (FL) has not shown an overall survival benefit over “watch and wait” (W/W) strategy. We estimated incidence of treatment initiation at specific time points and assessed its association with the presence of any criteria such as GELF, BNLI, GITMO at diagnosis. FL patients managed by W/W strategy were identified from the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma SPORE between 2002 and 2015. Cumulative incidence estimates of treatment initiation were calculated using transformation (as the first event) and death as competing risks. 401 FL patients were identified on W/W strategy. At a median follow-up of 8 years, 256 (64%) initiated treatment. For patients on the W/W strategy for 5 years, the likelihood of treatment initiation in the next 5 years was 12% compared to 43% at diagnosis unlike transformation rates which remained steady. Patients with any of popular treatment criteria at diagnosis did not have increased therapy initiation rates (44% vs. 42%) during the first 5 years or lymphoma-related death rates at 10 years (6% vs. 7%). Identifying biological differences in patients with early vs. late or no progression is a critical next step in understanding outcomes in W/W patients.
 

摘要翻译： 

对于无症状、低肿瘤负荷滤泡性淋巴瘤（FL）的即刻治疗，相较于“观察等待”（W/W）策略，并未显示出总生存获益。我们评估了在特定时间点启动治疗的发生率，并分析了其与诊断时是否存在GELF、BNLI、GITMO等标准的相关性。研究从2002年至2015年爱荷华大学/梅奥诊所淋巴瘤SPORE的分子流行病学资源库中筛选出接受W/W策略管理的FL患者。以转化为首发事件和死亡作为竞争风险，计算了启动治疗的累积发生率。共识别出401例采用W/W策略的FL患者。在中位随访8年期间，256例（64%）患者启动了治疗。对于持续5年采用W/W策略的患者，其在随后5年内启动治疗的可能性为12%，而诊断时即刻治疗的可能性为43%——这与持续稳定的转化率形成对比。诊断时符合任一常用治疗标准的患者，在前5年内的治疗启动率并未升高（44%对42%），10年淋巴瘤相关死亡率亦无差异（6%对7%）。识别早期进展与晚期或无进展患者之间的生物学差异，是理解W/W患者预后的关键下一步。

原文链接：

Patterns of therapy initiation during the first decade for patients with follicular lymphoma who were observed at diagnosis in the rituximab era