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Comparative outcomes of immunochemotherapy regimens in Waldenström macroglobulinaemia
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Personen und Körperschaften: | , , , , |
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Titel: |
Comparative outcomes of immunochemotherapy regimens in Waldenström macroglobulinaemia |
In: | British Journal of Haematology, 179, 2017, 1, S. 106-115 |
veröffentlicht: |
Wiley
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Umfang: | 106-115 |
ISSN: |
0007-1048 1365-2141 |
DOI: | 10.1111/bjh.14828 |
Zusammenfassung: | <jats:title>Summary</jats:title><jats:p>Comparative data on immunochemotherapy regimens for Waldenström macroglobulinaemia/lymphoplasmacytic lymphoma (<jats:styled-content style="fixed-case">WM</jats:styled-content>/<jats:styled-content style="fixed-case">LPL</jats:styled-content>) are lacking. We analysed overall survival (<jats:styled-content style="fixed-case">OS</jats:styled-content>), risk of hospitalizations, transfusions and plasmapheresis in a population‐based cohort of patients ≥65 years old initiating <jats:styled-content style="fixed-case">WM</jats:styled-content>/<jats:styled-content style="fixed-case">LPL</jats:styled-content> therapy in 1999–2013. To minimize bias, we applied a propensity score‐based causal inference method. We conducted three analyses of: patients treated with or without rituximab, patients treated with rituximab monotherapy or with combination immunochemotherapy, and regimens based on classic purine analogues or alkylators. Among 1310 patients, 78·5% received rituximab. Patients who received rituximab had significantly better <jats:styled-content style="fixed-case">OS</jats:styled-content> [hazard ratio (<jats:styled-content style="fixed-case">HR</jats:styled-content>) 0·62, 95% confidence interval (<jats:styled-content style="fixed-case">CI</jats:styled-content>) 0·55–0·71] and lower risk of transfusions (risk difference −3·3%, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> −6·3 to −0·3) than those who did not, without a significant difference in hospitalizations or plasmapheresis. We observed no significant difference in <jats:styled-content style="fixed-case">OS</jats:styled-content> (<jats:styled-content style="fixed-case">HR</jats:styled-content> 0·91, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0·79–1·04) between rituximab monotherapy and combination immunochemotherapy, but toxicity outcomes were lower with rituximab alone. Neither survival (<jats:styled-content style="fixed-case">HR</jats:styled-content> 1·10, 95%<jats:styled-content style="fixed-case">CI</jats:styled-content> 0·92–1·32) nor toxicity outcomes differed significantly between regimens based on purine analogues or alkylators. The survival advantage strongly supports rituximab as part of upfront therapy for <jats:styled-content style="fixed-case">WM</jats:styled-content>/<jats:styled-content style="fixed-case">LPL</jats:styled-content>, whereas regimens with either purine analogues or alkylating agents result in similar outcomes.</jats:p> |
Format: | E-Article |
Quelle: | Wiley (CrossRef) |
Sprache: | Englisch |