Patients with MYC rearranged (MYC-R) diffuse large B-cell lymphoma (DLBCL) have a poor prognosis. Previously, we demonstrated in a single-arm phase II trial (HOVON-130) that addition of lenalidomide to R-CHOP (R2CHOP) is well-tolerated and yields similar complete metabolic remission rates as more intensive chemotherapy regimens in literature. In parallel with this single-arm interventional trial, a prospective observational screening cohort (HOVON-900) was open in which we identified all newly diagnosed MYC-R DLBCL patients in the Netherlands. Eligible patients from the observational cohort that were not included in the interventional trial served as control group in the present risk-adjusted comparison. R2CHOP treated patients from the interventional trial (n = 77) were younger than patients in the R-CHOP control cohort (n = 56) (median age 63 versus 70 years, p = 0.018) and they were more likely to have a lower WHO performance score (p = 0.013). We adjusted for differences at baseline using 1:1 matching, multivariable analysis, and weighting using the propensity score to reduce treatment-selection bias. These analyses consistently showed improved outcome after R2CHOP with HRs of 0.53, 0.51, and 0.59, respectively, for OS, and 0.53, 0.59, and 0.60 for PFS. Thus, this non-randomized risk-adjusted comparison supports R2CHOP as an additional treatment option for MYC-R DLBCL patients.
MYC重排的弥漫性大B细胞淋巴瘤患者预后较差。此前，我们在单臂II期临床试验（HOVON-130）中证明，在R-CHOP方案中加入来那度胺（R2CHOP）耐受性良好，且与文献中更强化的化疗方案相比，可获得相似的完全代谢缓解率。与该单臂干预试验并行，我们开展了一项前瞻性观察性筛查队列研究（HOVON-900），旨在识别荷兰所有新诊断的MYC重排弥漫性大B细胞淋巴瘤患者。从观察性队列中符合条件但未参与干预试验的患者，在本项风险校正比较中作为对照组。干预试验中接受R2CHOP治疗的患者（n=77）比R-CHOP对照队列的患者（n=56）更年轻（中位年龄63岁对70岁，p=0.018），且更可能具有较低的WHO体能状态评分（p=0.013）。我们通过1:1匹配、多变量分析和倾向评分加权法校正基线差异，以减少治疗选择偏倚。这些分析一致显示，R2CHOP治疗后患者结局改善：总生存期的风险比分别为0.53、0.51和0.59，无进展生存期的风险比分别为0.53、0.59和0.60。因此，这项非随机风险校正比较支持R2CHOP作为MYC重排弥漫性大B细胞淋巴瘤患者的额外治疗选择。
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