JCO：香港研究者发现部分复发或难治性PTCL患者可经常规化疗取得良好结局

目前针对复发或难治性外周T细胞淋巴瘤(PTCL) 有大量处于研究阶段的新型治疗方法；然而，这些方法对患者结局的相对影响尚不明确。为此中国香港玛格丽特公主医院Vivien Mak等人进行了研究，该研究针对出现复发或进展且未进行造血干细胞移植的PTCL患者进行了研究，并考察影响患者生存的相关因素。研究对北美地区最常见的三种亚型进行了评价：未另作详细说明的PTCL(PTCL-NOS)、血管免疫母细胞性T细胞淋巴瘤(AITL)以及间变性大细胞淋巴瘤(ALCL; 间变性淋巴瘤激酶 [ALK] 阳性及ALK 阴性)。这项研究结果发表在2013年4月22日在线出版的《临床肿瘤学杂志》上。
研究人员经过筛除后，最终共对153例患者进行了分析(PTCL-NOS, n = 79 [52%]; AITL, n = 38 [25%]; ALK-阳性 ALCL, n = 11 [7%]; ALK-阴性 ALCL, n = 27 [16%; 其中包括 ALK状态未知患者, n = 1])
患者自最初确诊至出现首次治疗后复发或进展的中位时间为6.7个月，患者出现复发的中位年龄为66岁(ALK-阳性 ALCL患者, 39 岁)。研究人员发现，出现复发或进展后的中位生存期(OS)及中位无进展生存期(PFS，第二PFS)分别为5.5个月和3.1个月，这一结果仅比在复发后接受化疗的患者稍好(n = 89 [58%]; 6.5个月及3.7个月)。在复发时接受化疗且处于0或1级较好功能状态(PS)的患者，可取得较好的OS (P<.001; 中位OS, 13.7个月)及PFS (P=.006; 第二PFS中位值, 5.0 个月)结局，经多变量分析后，该结果仍具有显著性(OS: 风险比[HR], 2.09; P=.002;第二 PFS: HR, 1.66; P=.030)。
该研究最后认为，多数复发或难治性PTCL患者结局较差且生存期较短。经过筛选，部分PS较好的患者可经常规化疗取得良好结局。
与淋巴瘤相关的拓展阅读：

• Lancet Oncol：Crizotinib可用于治疗炎性肌纤维母细胞瘤和间变性大细胞淋巴瘤儿童患者
• JNCI：抑制肉碱乙酰基转移酶可预防Myc诱导的淋巴瘤生成
• NEJM：利妥昔单抗方案治疗纵隔B细胞淋巴瘤可避免放疗
• JCO:ABVD标准治疗方案不适用于老年霍奇金淋巴瘤
• Blood：红斑狼疮治疗药不增加淋巴瘤风险
• NEJM：霍奇金淋巴瘤患儿药物短缺不容小觑
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Survival of Patients With Peripheral T-Cell Lymphoma After First Relapse or Progression: Spectrum of Disease and Rare Long-Term Survivors
Introduction
A number of novel therapies are under investigation in relapsed or refractory peripheral T-cell lymphoma (PTCL); however, their relative impact on outcome is unknown. We examined the survival of patients with PTCL after relapse or progression in the absence of hematopoietic stem-cell transplantation and explored factors influencing survival. The three most common subtypes encountered in North America were evaluated: PTCL not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), and anaplastic large-cell lymphoma (ALCL; anaplastic lymphoma kinase [ALK] positive and ALK negative.
Patients and Methods
After exclusions, 153 patients were analyzed (PTCL-NOS, n = 79 [52%]; AITL, n = 38 [25%]; ALK-positive ALCL, n = 11 [7%]; ALK-negative ALCL, n = 27 [16%; including ALK status unknown, n = 1]).
Results
Median time from initial diagnosis to relapse or progression after primary therapy was 6.7 months, and median age at relapse was 66 years (ALK-positive ALCL, 39 years). Median overall survival (OS) and median progression-free survival (PFS) after relapse or progression (second PFS) were 5.5 and 3.1 months, respectively, and were only marginally better in patients who received chemotherapy at relapse (n = 89 [58%]; 6.5 and 3.7 months, respectively). Patients with good performance status (PS) of 0 or 1 (n = 47) at relapse who received chemotherapy had a more favorable OS (P < .001; median OS, 13.7 months) and PFS (P = .006; median second PFS, 5.0 months), which remained significant in multivariate analysis (OS: hazard ratio [HR], 2.09; P = .002; second PFS: HR, 1.66; P = .030).
Conclusion
Most patients with relapsed or refractory PTCL have poor outcomes with short survival. Select patients with good PS have more favorable outcomes with standard chemotherapy.