Непосредственные и отдаленные результаты высокодозной химиотерапии с трансплантацией аутологичных гемопоэтических стволовых клеток в первой линии лечения диффузной В-клеточной крупноклеточной лимфомы

Введение. Высокодозная химиотерапия (ВДХТ) с трансплантацией аутологичных гемопоэтических стволовых клеток (ТГСК) в первой линии лечения является перспективной клинической опцией для консолидации ремиссии у пациентов с диффузной В-клеточной крупноклеточной лимфомой (ДВКЛ).

Цель. Улучшить исходы у пациентов с ДВКЛ IV стадии при IPI ≥2 при помощи проведения ВДХТ с ауто-ТГСК в первой линии лечения.

Материалы и методы. В исследование включено 105 пациентов 18-65 лет с CD20(+) ДВКЛ NOS, IPI ≥2, получивших х6 CHOP/EPOCH + R в НМИЦ онкологии имени Н.Н. Петрова с 2010 по 2019 гг. Пациентам проводилась ВДХТ с ауто-ТГСК в первой ремиссии (группа ТГСК) (n = 35) или динамическое наблюдение (группа контроля, n =70).

Результаты и обсуждение. Было отмечено увеличение трехлетней БРВ (p = 0,018) и ОВ (p = 0,01), увеличение частоты полного ответа (ПО) в группе ТГСК (p < 0,001). Ранний рецидив показан независимым неблагоприятным прогностическим фактором для ОВ (p < 0,001), в группе ТГСК он отмечался реже (p = 0,027). Лимфома с двойной экспрессией (DEL) - фактор риска развития ранних (p < 0,001) и общих рецидивов (p < 0,001) в группе контроля и общей группе (p < 0,001 и p = 0,013). При сочетанном экстранодальном поражении с вовлечением легкого общие рецидивы отмечались чаще в группе контроля и общей группе (p = 0,004 и p = 0,021). DEL и сочетанное экстранодальное поражение с вовлечением легкого повышали вероятность рецидива в течение 2 лет после завершения лечения.

Заключение. ВДХТ с ауто-ТГСК возможна как клиническая опция для консолидации первой ремиссии у пациентов с IV стадией ДВКЛ, IPI £2 при наличии DEL и/или сочетанного экстранодального поражения с вовлечением легкого.

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