Background The prognosis of elderly patients with aggressive B-non-Hodgkin's lymphoma after first lymphoma-related treatment failure (TF-L) is not well described. Methods We analysed patient characteristics including the presence of MYC rearrangements and MYC-expression immunohistochemistry (IHC) at diagnosis and modalities of salvage therapy and their impact on the prognosis of patients between 61 and 80 years who had been treated on the RICOVER-60 trial. Results TF-L occurred in 301 of the 1222 (24.6%) patients; 297 patients could be analysed. Prognosis was extremely poor in patients with primary progressive disease or early relapse (≤12 months) with median survivals of 3.3 and 6.4 months. Survival after TF-L was significantly lower in patients pretreated with R-CHOP compared with CHOP (23.0% versus 36.4% at 2 years, P = 0.016). In patients with MYC translocation at diagnosis Rituximab reduced the risk of TF-L from 58.8% to 26.3%. Survival after TF-L was significant longer for patients after CHOP without MYC translocations (31.8% versus 0% at 2 years, P < 0.001) or negative MYC-IHC (41.0% versus 16.8% at 2 years, P = 0.017) but not after R-CHOP. 224 patients (75.4%) received salvage therapy. Rituximab was part of salvage therapy in 57.4% and improved 2-year survival rate from 20.7% to 46.8% (P < 0.001). The benefit of R was significant after first-line CHOP [2-year overall survival (OS) 49.6% versus 19.1%, P < 0.001] as well as after R-CHOP (2-year OS 33.1% and 22.5%, P = 0.034). For patients pretreated with R-CHOP long-term survival was below 15% regardless of the treatment chosen. Conclusion MYC rearrangement and IHC are adverse prognostic factors after TF-L for CHOP treated patients, rituximab as part of first-line therapy reduced the effects of MYC-break. Rituximab improves results of any type of salvage therapy; however, survival after progression/relapse of aggressive B-cell lymphoma in elderly patients pretreated with (R)-CHOP is poor regardless of treatment chosen.

中文翻译：

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难治性或复发性侵袭性 B 细胞淋巴瘤失败 (R)-CHOP：对接受 RICOVER-60 试验治疗的患者的分析。

背景 侵袭性 B 型非霍奇金淋巴瘤老年患者在首次淋巴瘤相关治疗失败 (TF-L) 后的预后没有得到很好的描述。方法 我们分析了患者特征，包括诊断时 MYC 重排和 MYC 表达免疫组织化学 (IHC) 的存在和挽救治疗的方式，以及它们对 RICOVER-60 试验中接受治疗的 61 至 80 岁患者预后的影响。结果 1222 例患者中有 301 例（24.6%）发生 TF-L；可以分析 297 名患者。原发进展性疾病或早期复发（≤12 个月）患者的预后极差，中位生存期为 3.3 和 6.4 个月。与 CHOP 相比，接受 R-CHOP 预处理的患者 TF-L 后的存活率显着低于 CHOP（2 年时分别为 23.0% 和 36.4%，P = 0.016）。在诊断为 MYC 易位的患者中，利妥昔单抗将 TF-L 的风险从 58.8% 降低到 26.3%。对于 CHOP 后没有 MYC 易位（2 年 31.8% 对 0%，P < 0.001）或 MYC-IHC 阴性（41.0% 对 2 年 16.8%，P = 0.017）的患者，TF-L 后的存活率显着延长，但不是在 R-CHOP 之后。224 名患者（75.4%）接受了抢救治疗。利妥昔单抗是 57.4% 的抢救治疗的一部分，并将 2 年生存率从 20.7% 提高到 46.8% (P < 0.001)。在一线 CHOP [2 年总生存期 (OS) 49.6% 对 19.1%，P < 0.001] 以及 R-CHOP 后（2 年 OS 33.1% 和 22.5%，P = 0.034)。对于预先接受 R-CHOP 治疗的患者，无论选择何种治疗，长期生存率均低于 15%。结论 MYC 重排和 IHC 是 CHOP 治疗患者 TF-L 后的不良预后因素，利妥昔单抗作为一线治疗的一部分降低了 MYC-break 的影响。利妥昔单抗可改善任何类型抢救治疗的结果；然而，无论选择何种治疗方法，用 (R)-CHOP 预处理的老年患者侵袭性 B 细胞淋巴瘤进展/复发后的存活率都很差。