滤泡性淋巴瘤国际预后指数2在利妥昔单克隆抗体维持治疗滤泡性淋巴瘤患者中的预后意义

摘要

Objective:To investigate the prognostic significance of Follicular Lymphoma International Prognostic Index 2 (FLIPI2) in FL patients treated with rituximab maintenance.Methods:A tatol of 140 newly diagnosed FL patients who received Rituximab plus cyclophosphamide,doxorubicin,vincristine and prednisone (R-CHOP) chemotherapy in our department were retrospectively analyzed from December 2002 to December 2014.Among 140 patients with FL 122 patients achieved response,from them 56 patients received R maintenance (RM) every 2 months for median 8 times (RM group) while the rest 66 patients did not receive further anti-lymphoma treatment (non-RM group).Results:There was no statistical difference in age,sex,pathologic grading,staging,FLIPI or FLIPI2 between RM and non-RM groups.The 2-year progression-free survival (PFS) of RM and non-RM groups were 89.7％ and 77.6％ (P =0.043) while the 2-year overall survival were 100％ and 98.6％ (P =0.131).FLIPI2 is a significant prognostic model either in the total cohort,RM or non-RM groups (P ＜0.001 all).In subgroup analysis,RM was able to decrease disease progression in low and intermediate-risk group of FLIPI2,while the 2-year PFS of RM and non-RM groups in high-risk group were similar (55.6％ vs 46.9％)(P =0.920).Conclusion:FLIPI2 presents robust prognostic significance either in RM or OBS patients,the patients in FLIPI2 low and intermediate-risk group may benefite from RM,but the role of RM in high-risk patients should be further to investigate.%目的:探讨滤泡性淋巴瘤国际预后指数2(FLIPI2)在滤泡性淋巴瘤(FL)中的预后意义,以期寻找更适合维持治疗的人群,为个体化治疗进行更深入的探索.方法:对2002年12月至2014年12月以利妥昔单克隆抗体联合环磷酰胺、多柔比星、长春新碱及泼尼松(R-CHOP)化疗方案治疗的140例初治FL患者进行回顾性分析.140例中122例经过治疗后获得缓解,其中56例接受2个月1次利妥昔单克隆抗体维持(RM),中位维持8次(RM组);66例不接受任何抗淋巴瘤药物治疗(non-RM组).结果,RM组及non-RM组在年龄、性别、病理分级、AnnArbor分期、FLIPI及FLIPI2评分等临床及病理特征方面均无显著性差异.RM组和non-RM组的2年无进展生存(PFS)分别为89.7％和77.6％ (P =0.043),其2年总生存(OS)分别为100％和98.6％ (P=0.131).无论在整体队列、RM组或non-RM组中,FLIPI2均可将患者分为预后显著差异的3个危险组别(P ＜0.001).亚组分析显示,FLIPI2低危及中危患者RM组较non-RM组的PFS显著提升;但在FLIPI2高危组中,RM与non-RM组的2年PFS率分别为55.6％和46.9％(P=0.920).结论:经一线R-CHOP方案治疗缓解的FL患者,无论是否行RM,FLIPI2均对其预后判别具有重要意义.FLIPI2低危及中危患者均可以从RM治疗中获益,但是高危患者中RM治疗的意义仍值得进一步明确.