弥漫大B细胞性淋巴瘤临床病理特点与利妥昔单抗疗效的关系  

Relationship between cllnopathological features and outcome of rituximab treatment for diffuse large B-cell iymphoma

作　　者：张红雨[1] 管忠震[1] 汪波[1] 黄慧强[1] 夏忠军[1] 林桐榆[1] 

机构地区：[1]中山大学肿瘤防治中心内科,广州510060

出　　处：《中华肿瘤杂志》2008年第5期381-384,共4页Chinese Journal of Oncology

基　　金：广东省科技计划资助项目（2003C30314）

摘　　要：目的探讨弥漫大B细胞性淋巴瘤（DLBCL）临床病理特点与利妥昔单抗疗效之间的关系。方法回顾性分析69例采用利妥昔单抗联合化疗治疗DLBCL患者的临床资料，探讨DLBCL临床病理特征对疗效的影响。应用免疫组化SP法检测Bcl-2、survivin及bax蛋白的表达，分析其表达与利妥昔单抗疗效之间的关系。结果采用利妥昔单抗联合化疗治疗初治DLBCL患者，有效率为90．7％，完全缓解（CR）率为69．8％；难治或复发患者的有效率为80．8％，CR率为30．8％。分期晚（P=0．046）、血清乳酸脱氢酶（LDH）水平较高（P=0．024）、难治或复发（P=0．009）以及合并大肿块（P=0．013）的患者疗效明显差。Bcl-2表达阳性者的疗效明显好于阴性者（P=0．04）；bax和survivin的表达则与疗效无关（P〉0．05）。结论利妥昔单抗联合化疗治疗DLBCL患者，有效率和CR率较高，且患者耐受性良好。但分期较晚、LDH水平较高、难治或复发、合并大肿块以及Bcl-2表达阴性患者的疗效较差。Objective To investigate the relationship of clinopathological features and outcome of rituximab treatment for diffuse large B-cell lymphoma （DLBCL）. Methods Sixty-nine patients with DLBCL received intravenous infusion of rituximab in combination with different chemotherapy regimens have been retrospectively analyzed. The influencing factors such as age, stage, serum level of lactate dehydrogenase （LDH） and bulky disease were analyzed retrospectively in terms of the response. The anti-/ pro-apoptosis proteins were detected by immunohistochemistry （ SP methods ）. The correlation of protein expression with efficacy of rituximab treatment was also analyzed. Results In the patients with previously untreated aggressive B-NHL, the combination of rituximab with chemotherapy achieved an overall response rate （ORR） of 90.7% and CR of 69.8%, while in the patients with relapsed disease, that was 80.8% （ORR） and 30.8% （CR）. The disease stage （ P = 0. 046 ） , serum lactate dehydrogenase （ LDH ） （ P = 0. 024）, physical status （P = 0.009） and bulky disease （P = 0. 013 ） were found to be unfavorable factors for the immunochemotherapy. The treatment efficacy in the patients with Bcl-2 overexpression was better than that in cases with negative one. No correlation of the bax and survivin expression with immunochemotherapy efficacy was observed. Conclusion The immunochemotherapy regimen （rituximab plus chemotherapy） can improve the response rate and CR rate without significant increase in toxicity in patients with diffuse large Bcell lymphoma. The advanced stage, high serum LDH level, relapsed disease, bulky disease and negative Bcl-2 expression are unfavorable factors affecting the therapeutic efficacy.

关 键 词：利妥昔单抗 弥漫大B细胞性淋巴瘤 BCL-2 

分 类 号：R686[医药卫生—骨科学]