文章：

原发性纵隔大B细胞淋巴瘤中优化实施的R-da-EPOCH与R-CHOP-21方案对比：一项单中心真实世界研究

Optimally Delivered R-da-EPOCH Versus R-CHOP-21 in Primary Mediastinal Large B-Cell Lymphoma: A Real-Life Comparison in a Single Academic Center

原文发布日期：19 May 2025

DOI: 10.3390/cancers17101699

类型: Article

开放获取: 是

英文摘要：

Background/Objectives: The National Cancer Institute introduced the intensified R-da-EPOCH regimen in primary mediastinal large B-cell lymphoma (PMLBCL) to improve outcomes while minimizing radiotherapy use. However, there is no randomized comparison of R-da-EPOCH vs. R-CHOP-21. The objective of this study was to compare R-da-EPOCH with R-CHOP-21 in consecutive patients with PMLBCL of a single, large referral center, where the R-da-EPOCH escalation schedule was strictly followed. Methods: We retrospectively analyzed all 35 consecutive patients who received R-da-EPOCH (2017–2022) compared to 35 consecutive patients treated with R-CHOP-21 arm at the same Department, starting from the most recent patient and going backwards (2005–2017). Results: R-da-EPOCH was given strictly in 33/35 (94%) patients. The 5-year freedom from progression (FFP) was 91% vs. 69% (p= 0.027). The 5-year event-free survival (EFS) was 84% vs. 69% (p= 0.124). The 5-year overall survival (OS) was 97% vs. 80% (p= 0.063). Among R-CHOP-21-responders, 20/29 (69%) received RT compared to 2/34 (6%) R-da-EPOCH-responders. In multivariate analysis, R-da-EPOCH remained better than R-CHOP-21 in terms of FFP [hazard ratios (HRs) 0.21–0.26, allp< 0.05] and was associated with very favorable HR for EFS and OS. Conclusions: Optimally delivered R-da-EPOCH minimized the use of RT in a real-life setting and provided superior outcomes than R-CHOP-21.

摘要翻译： 

背景/目的：美国国家癌症研究所针对原发性纵隔大B细胞淋巴瘤（PMLBCL）引入强化R-da-EPOCH方案，旨在改善疗效并减少放疗使用。然而目前尚无R-da-EPOCH与R-CHOP-21方案的随机对照研究。本研究旨在大型转诊中心严格遵循R-da-EPOCH剂量递增方案的前提下，比较连续收治的PMLBCL患者接受R-da-EPOCH与R-CHOP-21方案的疗效差异。方法：我们回顾性分析了2017-2022年间连续接受R-da-EPOCH方案治疗的35例患者，并与同一科室自最近病例开始逆向选取的连续35例R-CHOP-21方案治疗患者（2005-2017年）进行比较。结果：94%（33/35）的患者严格遵循R-da-EPOCH方案治疗。5年无进展生存率（FFP）分别为91% vs 69%（p=0.027），5年无事件生存率（EFS）为84% vs 69%（p=0.124），5年总生存率（OS）为97% vs 80%（p=0.063）。在R-CHOP-21方案应答者中，69%（20/29）接受了放疗，而R-da-EPOCH方案应答者中仅6%（2/34）接受放疗。多变量分析显示，R-da-EPOCH方案在FFP方面显著优于R-CHOP-21[风险比（HR）0.21-0.26，所有p<0.05]，且在EFS和OS方面也呈现更有利的风险比。结论：在真实临床实践中，规范实施的R-da-EPOCH方案能最大限度减少放疗使用，且疗效优于R-CHOP-21方案。

原文链接：

Optimally Delivered R-da-EPOCH Versus R-CHOP-21 in Primary Mediastinal Large B-Cell Lymphoma: A Real-Life Comparison in a Single Academic Center