Excellent outcomes of transformed lymphomas in the rituximab era without autologous stem cell transplantation: an Australian single-centre experience.

Autor: Tedjaseputra A; Monash Haematology, Monash Health, Melbourne, Victoria, Australia., Gilbertson M; Monash Haematology, Monash Health, Melbourne, Victoria, Australia.; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia., Low M; Monash Haematology, Monash Health, Melbourne, Victoria, Australia.; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia., Fedele PL; Monash Haematology, Monash Health, Melbourne, Victoria, Australia.; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia., Kumar B; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.; Department of Anatomical Pathology, Monash Health, Melbourne, Victoria, Australia., Simpson I; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.; Department of Anatomical Pathology, Monash Health, Melbourne, Victoria, Australia., Grigoriadis G; Monash Haematology, Monash Health, Melbourne, Victoria, Australia.; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia., Shortt J; Monash Haematology, Monash Health, Melbourne, Victoria, Australia.; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia., Opat S; Monash Haematology, Monash Health, Melbourne, Victoria, Australia.; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia., Gregory GP; Monash Haematology, Monash Health, Melbourne, Victoria, Australia.; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: Internal medicine journal [Intern Med J] 2021 Nov; Vol. 51 (11), pp. 1825-1834. Date of Electronic Publication: 2021 Oct 24.
DOI: 10.1111/imj.14965
Abstrakt: Background: Histologic transformation (HT) is an important event with adverse prognosis in the natural history of indolent lymphomas. There are minimal data on HT in the Australian setting.
Aims: To characterise patients with biopsy-proven HT and their outcomes identified at a tertiary Australian Hospital.
Methods: All patients with biopsy-proven HT during a 15-year period (2002-2017) were included. Clinico-pathological data were systematically collected from review of patient records. Survival estimates were assessed using the Kaplan-Meier method and compared using the log-rank test. Associations between variables and clinical outcomes were evaluated using Cox's proportional hazards model.
Results: A cohort of 45 patients was identified with a median age of 66 years and the majority (59%) having high-risk disease (Revised-International Prognostic Index score ≥3). R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) induction was used in 69%, with an overall response rate of 82% (complete response (CR), 75%). Sixty-one percent of these induction responders received consolidation, with autologous stem cell transplant (ASCT) performed in only 17% and rituximab maintenance given to 31%. With a median follow up of 47 months (range: 4-136), the 5-year overall survival (OS) was 69% (95% CI: 52%, 81%). Chemotherapy-naivety at HT was associated with a superior rate of CR (84% vs 54%, P = 0.057) and 5-year OS (82% vs 46%, P = 0.012). Rituximab maintenance was associated with a durable progression-free survival in induction responders.
Conclusions: Excellent OS was observed in this modern cohort of patients treated with rituximab-containing induction and low rate of consolidation by ASCT, particularly in those who were chemotherapy-naïve at HT.
(© 2020 Royal Australasian College of Physicians.)
Databáze: MEDLINE
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