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Therapiestrategien beim diffusen großzelligen B-Zell-Lymphom

Treatment strategies for diffuse large B-cell lymphomas

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Zusammenfassung

Der Internationale Prognose-Index (IPI) erlaubt eine prognostische Einteilung von Patienten mit aggressiven Lymphomen. Die besten Ergebnisse bei jungen Patienten mit diffusen großzelligen Lymphomen (DLBCL) und guter Prognose (niedriges und intermediär-niedriges Risiko bzw. altersadaptierter IPI = aaIPI = 0,1) wurden mit 6 Zyklen CHOP-21 plus Rituximab erzielt. Damit erreichen Patienten mit einer sehr günstigen Prognose (IPI = 0, kein Bulk) ereignisfreie Überlebensraten von  > 90% und Dreijahresüberlebensraten von 98%, während Patienten in der weniger günstigen Subgruppe (IPI = 1, IPI = 0 mit Bulk) ein ereignisfreies Überleben von unter 80% haben, was einer weiteren Verbesserung bedarf. Junge Patienten mit schlechter Prognose (intermediär-hohes und hohes Risiko bzw. aaIPI = 2,3) erreichten die besten Ergebnisse mit 8 Zyklen CHOEP-14 plus Rituximab, mit einem Gesamtüberleben nach 3 Jahren von ca. 85%. Bei älteren Patienten führten 6 Zyklen CHOP-14 und 8 Applikationen Rituximab zu den besten Ergebnissen, sodass diese Therapie, die im Gegensatz zu 8 Zyklen R-CHOP-21 eine kürzere Therapiedauer und geringere kumulative Toxizität hat, für ältere Patienten derzeit als Standard gelten kann. Zusammengefasst sind außer für die jungen Patienten mit sehr günstiger Prognose weitere Verbesserungen der Therapieergebnisse dringend notwendig, die nur innerhalb von prospektiven randomisierten Studien erreicht und demonstriert werden können.

Abstract

The International Prognostic Index (IPI) distinguishes different prognostic groups of patients with aggressive lymphoma. The best results for young patients with diffuse large B-cell lymphomas (DLBCL) and a good prognosis (low and low-intermediate risk group or age-adjusted IPI/aaIPI = 0.1) are obtained with 6 cycles of CHOP-21 plus rituximab. With this approach event-free survival rates of > 90% and overall survival of 98% can be achieved in a very favorable subgroup (aaIPI = 0, no bulky disease), while further improvement is warranted for the less favorable (aaIPI = 1 or aaIPI = 0 with bulk). For young patients with a poor prognosis (intermediate-high and high risk or aaIPI=2.3) the 3-year survival is  approximately 85% with 8 cycles of CHOEP-14 plus rituximab. In elderly patients 6 cycles of CHOP-14 with 8 administrations of rituximab achieved the best results (78% overall survival after 2.5 years) to date and should therefore be considered standard for these patients. In summary, except for young patients with a very favorable prognosis, where treatment reduction has been studied in the randomized FLYER trial of the DSHNHL, the prognosis of the other subgroups of patients still warrants further improvement which can be only achieved and demonstrated within prospective randomized trials.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Prof. Pfreundschuh ist Mitglied des Advisory Board von Roche und Celgene.

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Authors and Affiliations

  1. Deutsche Studiengruppe Hochmaligne Non-Hodgkin-Lymphome (DSHNHL), Innere Medizin I, Universität des Saarlandes, Kirrberger Straße, 66421, Homburg, Deutschland

    G. Held, N. Murawski &  M. Pfreundschuh

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  1. G. Held
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  2. N. Murawski
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  3. M. Pfreundschuh
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Correspondence to M. Pfreundschuh.

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Held, G., Murawski, N. & Pfreundschuh, M. Therapiestrategien beim diffusen großzelligen B-Zell-Lymphom. Onkologe 17, 789–798 (2011). https://doi.org/10.1007/s00761-011-2127-4

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  • DOI: https://doi.org/10.1007/s00761-011-2127-4

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