淋巴瘤患者的死因？

橙色雨丝

最近举行的卢加诺国际淋巴瘤大会上，公布了一项临床研究的结果，是美国和法国的研究人员对在美罗华时代滤泡性淋巴瘤患者死因的分析，放在这里供所有有兴趣了解的淋巴瘤病友参考。

CAUSE OF DEATH IN FOLLICULAR LYMPHOMA IN THE RITUXIMAB ERA: A POOLED ANALYSIS OF FRENCH AND US COHORTS

Introduction: Although the life expectancy of patients with follicular lymphoma (FL pts) has increased, little is known regarding their cause of death (COD) in the current treatment era.

尽管滤泡性淋巴瘤患者的预期寿命延长了，但是在目前的治疗手段下患者的死因尚不明确。
Methods: Two cohorts were pooled of 1643 newly diagnosed pts with de novo FL enrolled since 2001 at Lyon University Hospital [N = 723, median follow-up (FU) 86 m] and the University of Iowa and Mayo Clinic Specialized Program of Research Excellence [SPORE, N = 920, median FU 84 m]. COD was classified as due to lymphoma, treatment-related (TRM, including infection, cardiac and secondary MDS/ AML), second cancer, other, or missing.

2001年以来对法国（Lyon）和美国（SPORE）的两组共1643例初治滤泡性淋巴瘤患者进行了86个月的随访。死亡原因分为淋巴瘤、治疗相关（包括感染，心脏，继发白血病）、二次肿瘤、其它和失访等几类。

Results: At a median FU of 85 months for pts still alive, there were 283 (17.2%) deaths. The 10 year overall survival (OS) was comparable in the Lyon (80%) and SPORE (77%) cohorts. Lymphoma (49%) was the most common COD followed by TRM (15%) (7% infection, 4% MDS/ AML and 2% cardiac), second cancer (12%), unrelated other causes (12%), and missing (12%). Of the 140 pts who died from lymphoma (median OS of 50 m), 77 (55%) had a transformed disease. In pts <60y, lymphoma was the leading COD (59%), followed by TRM (19%, of whom 50% had an ASCT); in pts ≥60y it was lymphoma (45%), followed by second cancer (15%) and other causes (15%). Pts who were initially observed died less frequently from lymphoma than those initially treated (38% vs 53%, P = 0.02). Death due to lymphoma remained the most common cause over follow-up time: <1y (51%), 1-4.9y (50%), 5-9.9y (48%) and >10y (50%). Lymphoma was the principal COD among pts failing to achieve event free survival at 24 m (EFS24, 56%) compared to pts who achieved EFS24 (37%, P = 0.003); among pts initially treated with immunochemotherapy, 86% who did not achieve EFS24 died from lymphoma or TRM compared to 59% achieving EFS24 (P < 0.001). Transformation occurred in 91 pts and accounted for 85% of the deaths in these cases, while only 33% of the pts without transformation died from lymphoma (P < 0.001). Death due to lymphoma after transformation was the leading COD in pts who died within 1y of diagnosis (32%), but this decreased over follow-up time: 1-5y (30%), 5-10y (23%) and >10y (15%). Pts who had a transplant (N = 45, autologous, ASCT) died more frequently from TRM (12/45, 27%) compared to no transplant (30/238, 12%, P = 0.02). Among the 24 pts without transformation and treated with an ASCT, 46% (11/24) died from TRM compared to 15% for the 166 pts without transformation and treated without ASCT (P < 0.001).

一共发生了283例死亡事件（17.2%），10年总生存率分别是80%（Lyon）和77%（SPORE）。淋巴瘤是最常见死因（49%），其次是治疗相关（15%），二次肿瘤（12%），不相关和失访也各占12%。140例死于淋巴瘤的患者中（中位生存期50个月），77例（55%）发生了转化。小于60岁的患者的主要死因是淋巴瘤（59%）；24个月内复发的患者56%死于淋巴瘤，24个月后复发的患者只有37%死于淋巴瘤；91例发生了转化并且85%的患者死因是转化，只有33%的未转化患者死因是淋巴瘤；进行了自体干细胞移植的患者死于治疗相关原因的比例是27%（12/45），未移植患者死于治疗相关原因的比例是12%（30/238）；24例未发生转化的患者，在自体干细胞移植后46%死于治疗相关的原因，相比之下166例未转化也未移植的患者只有15%死于治疗相关的原因。

Conclusion: Lymphoma, particularly after transformation, is the leading COD over the first 10 years from diagnosis in newly diagnosed FL pts in the rituximab era: regardless of age, time of progression/ transformation, EFS24 achievement, or treatment. TRM, and particularly death after ASCT, is of concern, supporting the development of less toxic therapies.

在美罗华时代，初治滤泡性淋巴瘤患者在第一个十年内，主要死因是淋巴瘤，特别是发生转化的淋巴瘤，无论年龄，进展或转化的时间，24个月无进展生存率，或治疗手段。治疗相关死亡率，特别是自体干细胞移植后的死亡率，值得关注，支持开发毒性更小的治疗方法。

总结：不治疗，大约有90%的可能性最终死于淋巴瘤；积极治疗，大约有50%的可能性最终死于淋巴瘤，另外有15%的可能性死于治疗本身的毒性。借用《勇敢的心》中威廉姆.华莱士的经典台词：

Fight, and you may die.   战斗，你可能会死

Run, and you’ll live...   逃跑，你能活着

at least awhile.   至少活一阵子

And dying in your beds many years from now. 或许多年后在床上老死

would you be willing to trade   但你们是否愿意

all the days from this day to that   用所有苟延残喘的日子，来交换今天

for one chance, just one chance   这一个机会，就这么一个机会

to come back here and tell our enemies   到这里告诉我们的敌人

that they may take our lives,   他们或许会杀死我们

but they’ll never take our freedom!   但他们夺不去我们的自由!

祈求平安。

多么艰难的选择。

阿瑶啊

看来要干细胞移植的话真的得慎重考虑

钢豌豆

我的一个老美病友（一个成功的建筑商人）患淋巴瘤5年后去世，他死于突发性心脏病，他是滤泡型，他CR了5年，他击败了淋巴瘤，但心脏病没有放过他，不知道他的心脏病跟淋巴瘤有啥关系，他以前没有心脏病。

Robinson

看来滤泡转化后的预后还是很艰难啊！不过这几年新药上市是不是也有很大改善了呢？有个问题是：如果CR了是不是意味着没有转化风险了，转化是不是只出现在带瘤的情况下？

一杯茗茶

我父亲是滤泡性淋巴瘤，目前二疗中，祈祷父亲可以成功战胜淋巴瘤，颐养天年

大福娃

挺好的了，十年生存率80%，平时尽情happy就行了，哈哈

坚持胜利@

慎重移植

橙色雨丝

Robinson 发表于 2017-6-24 10:20
看来滤泡转化后的预后还是很艰难啊！不过这几年新药上市是不是也有很大改善了呢？有个问题是：如果CR了是不 ...

不是。

希望永远都在

钢豌豆 发表于 2017-6-24 09:57
我的一个老美病友（一个成功的建筑商人）患淋巴瘤5年后去世，他死于突发性心脏病，他是滤泡型，他CR了5年 ...

我了解的一点知识、美罗华会引起心脏、肝脏等一些问题、我以前心脏很好、但用美罗华后、现在心脏有时会痛。另外我结疗后、现在浑身酸痛、一点力气也没有、不知你及友友们是否有这种感受！

WZL8200

学习了

期待康复

希望永远都在 发表于 2017-6-24 11:28
我了解的一点知识、美罗华会引起心脏、肝脏等一些问题、我以前心脏很好、但用美罗华后、现在心脏有时会痛 ...

你用的单美罗华？

期盼未来

这真是一个可怕的慢性凌迟的病啊

卤猪蹄

说得好！

向日葵大美妞

我五疗后也时而会有心脏难受的感觉。

希望永远都在

期待康复 发表于 2017-6-24 12:47
你用的单美罗华？

不是、有化疗药物、一共做了六个疗程！

阳光透过树叶

谢谢雨丝科普

佰翔

希望永远都在 发表于 2017-6-24 11:28
我了解的一点知识、美罗华会引起心脏、肝脏等一些问题、我以前心脏很好、但用美罗华后、现在心脏有时会痛 ...

我家的也是 六疗后结疗

希望永远都在

钢豌豆 发表于 2017-6-24 09:57
我的一个老美病友（一个成功的建筑商人）患淋巴瘤5年后去世，他死于突发性心脏病，他是滤泡型，他CR了5年 ...

你好：我知道你用美罗华巩固治疗、祝你开心快乐、平安幸福！希望你仍然到这个平台上发表自己在美国的治疗接触到的一些事情、让广大战友了解更多的外面世界。谢谢你！

孙生

学习了！好心态，不劳累，注意饮食～