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Abstract：
UNASSIGNED: Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is considered the standard-of-care for patients with advanced-stage diffuse large B-cell lymphoma (DLBCL), despite findings that patients with nongerminal center B-cell like (non-GCB) have significantly worse outcome with this regimen. We evaluated the prognostic significance of baseline risk factors, including cell of origin (COO) classified by the Hans algorithm, within an alternative chemoimmunotherapy program. At Memorial Sloan Kettering Cancer Center (MSK), 151 patients with DLBCL received sequential R-CHOP induction and (R)-ICE (rituximab, ifosfamide, carboplatin, and etoposide) consolidation. Outcome analysis based on COO was validated with a propensity score-matched cohort treated with R-CHOP from the Mayo Clinic component of the Molecular Epidemiology Resource (MER). Among the patients with GCB (n = 69) and non-GCB (n = 69) at MSK, event-free survival (EFS) of non-GCB was superior to that of GCB (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.29-0.98). Overall survival (OS) demonstrated an association in the same direction but was not statistically significant (HR, 0.68; 95% CI, 0.33-1.42). Propensity score-matched patients from MSK (n = 108) demonstrated a small attenuation in the HRs for EFS (HR, 0.57; 95% CI, 0.27-1.18) and OS (HR, 0.76; 95% CI, 0.33-1.79) and were no longer statistically significant. In contrast, the matched MER cohort (n = 108) demonstrated an EFS association (HR, 1.17; 95% CI, 0.70-1.95) and OS association (HR, 1.13; 95% CI, 0.64-2.00) in the opposite direction, but were also not statistically significant. R-CHOP induction and (R)-ICE consolidation may overcome the negative prognostic impact of the non-GCB phenotype, per the Hans algorithm, and can be preferentially selected for this population. This trial was registered at www.ClinicalTrials.gov as #NCT00039195 and #NCT00712582.
摘要：
利妥昔单抗,环磷酰胺,阿霉素,长春新碱,泼尼松（R-CHOP）被认为是晚期弥漫性大B细胞淋巴瘤（DLBCL）患者的标准治疗方法，尽管发现非生发中心B细胞样（非GCB）患者使用该方案的结局明显较差。我们评估了基线危险因素的预后意义，包括由汉斯算法分类的起源细胞(COO)，在替代化学免疫疗法计划中。在纪念斯隆·凯特琳癌症中心（MSK），151例DLBCL患者接受了序贯R-CHOP诱导和（R）-ICE（利妥昔单抗，异环磷酰胺,卡铂,和依托泊苷)巩固。基于COO的结果分析通过分子流行病学资源（MER）的MayoClinic部分的R-CHOP治疗的倾向评分匹配队列进行验证。在MSK的GCB（n=69）和非GCB（n=69）患者中，非GCB的无事件生存率（EFS）优于GCB（HR0.53，95％CI0.29-0.98）。总生存期（OS）表现出相同方向的相关性，但无统计学意义（HR0.68，95％CI0.33-1.42）。来自MSK的倾向评分匹配的患者(n=108)表现出EFS(HR0.57,95%CI0.27-1.18)和OS(HR0.76,95%CI0.33-1.79)的HR的小衰减,并且不再具有统计学意义。相比之下,匹配的MER队列（n=108）显示出相反方向的EFS关联（HR1.17，95％CI0.70-1.95）和OS关联（HR1.13，95％CI0.64-2.00），但也没有统计学意义。R-CHOP诱导和（R）-ICE巩固可以克服非GCB表型的负面预后影响，根据汉斯算法，并且可以优先选择用于该群体。
