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Therapie großzelliger Lymphome

Treatment of aggressive lymphomas

  • Schwerpunkt: Maligne Lymphome
  • Published:
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Zusammenfassung

Der altersadaptierte Internationale Prognoseindex (IPI) erlaubt eine klinisch relevante Einteilung jüngerer Patienten (≤60 Jahre) mit aggressiven Lymphomen. Mit 6 Zyklen CHOP-21 und Rituximab (R-CHOP-21) erzielen Patienten mit einer sehr günstigen Prognose (IPI 0, ohne Bulk) ein ereignisfreies Überleben nach 3 Jahren von >90%. Patienten in der weniger günstigen Prognosegruppe (IPI 1, IPI 0 mit Bulk) erreichen dagegen mit 6 Kursen R-CHOP-21 ein ereignisfreies Überleben nach 3 Jahren von weniger als 80%, das es zu verbessern gilt. Junge Patienten mit ungünstigerem Risikoprofil weisen ein 5-Jahres-Überleben von nur 60% auf. Dosisdichte Therapien und autologe Stammzelltransplantation werden für die Verbesserung der Ergebnisse innerhalb dieser Patientengruppe in Studien geprüft. Bei älteren Patienten ist der Vorteil einer kombinierten Immunochemotherapie eindeutig belegt. Die bislang besten Ergebnisse wurden für alle IPI-Gruppen der älteren Patienten (>60 Jahre) mit R-CHOP-14, gefolgt von 2 weiteren Applikationen Rituximab, erzielt.

Abstract

The age-adjusted International Prognostic Index (IPI) allows the definition of clinically relevant subgroups in younger patients (≤60 years) with aggressive lymphomas. Six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone-21 (CHOP-21) with rituximab (R-CHOP-21) achieved an event free survival after 3 years of >90% in patients with a very good prognosis (IPI 0, without bulk). In contrast, in patients from the less favourable groups (all IPI 1, IPI 0 with bulk only), the same therapy resulted in an event-free survival at 3 years of less than 80%. This requires improvement. Young patients with a worse risk profile have a survival probability of 60% after 5 years. Dose dense therapeutic regimens and autologous stem cell transplantation are being applied to this patient group in clinical trials. For patients >60 years, the advantage of combined immunochemotherapy has been clearly documented. For patients >60 years from all IPI groups, the best results have so far been achieved with six courses of R-CHOP-14 followed by two additional applications of rituximab.

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Interessenkonflikt

Der Autor wird unterstützt durch einen „travel grant“ der Fa. Roche. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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  1. Medizinische Klinik I, Universitätsklinikum Saarland, Kirrberger Straße, 66421, Homburg, Deutschland

    B. Gleissner, C. Zwick &  M. Pfreundschuh

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  1. B. Gleissner
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  2. C. Zwick
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  3. M. Pfreundschuh
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Correspondence to M. Pfreundschuh.

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Gleissner, B., Zwick, C. & Pfreundschuh, M. Therapie großzelliger Lymphome. Internist 48, 389–395 (2007). https://doi.org/10.1007/s00108-007-1825-x

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  • DOI: https://doi.org/10.1007/s00108-007-1825-x

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