利妥昔单抗联合挽救化疗治疗复发或难治弥漫大B细胞性非霍奇金淋巴瘤的长期随访结果  

Long-term results of rituximab-based salvage chemotherapy for relapsed or refractory diffuse large B-cell lymphoma

作　　者：王潇潇[1,2] 黄慧强[1,2] 夏忠军[1,2] 林旭滨[1,2] 蔡清淸 高岩[1,2] 林泽晓[1,2] 林桐榆[1,2] 姜文奇[1,2] 

机构地区：[1]中山大学肿瘤防治中心内科/华南肿瘤学国家重点实验室 [2]中山大学血液病研究所,广东广州510060

出　　处：《南方医科大学学报》2010年第4期867-870,874,共5页Journal of Southern Medical University

摘　　要：目的旨在评价利妥昔单抗联合挽救化疗治疗复发难治弥漫大B细胞性非霍奇金淋巴瘤(DLBCL)的疗效和不良反应。方法中山大学肿瘤防治中心1998年10月至2009年11月使用利妥昔单抗共治疗69例复发难治DLBCL患者,其中男性40例,女性29例,中位年龄51.5岁(17-82岁)。所有患者均经病理确诊,并接受利妥昔单抗联合常用挽救化疗,化疗方案主要包括EPOCH、ICE、DHAP、GEMOX及GDP等。27例在初治时曾使用过利妥昔单抗,其余则在复发难治时与联合挽救化疗首次联合使用。结果69例患者中有64例可以评价疗效,5例未进行疗效评价。总体客观有效率为73.4%(47/64),完全缓解率为45.3%(29/47)。13例患者在挽救方案获得缓解后接受自体造血干细胞支持下的超大剂量化疗(AHSCT/HDT);主要不良反应为骨髓抑制、乏力及胃肠道反应。与利妥昔单抗相关的不良反应主要有寒战、发热和乏力。随访截止至2009年11月13日,中位随访40.6(3.7～179.9)月,有28例患者死于肿瘤进展,2例死于Ⅳ度骨髓抑制并严重感染,其余患者仍健在。中位生存时间为51.6月(3.7～179.9),第1、3和5年生存率分别为92%、62%和37%。初治未使用利妥昔单抗患者的生存期较初治曾使用利妥昔单抗组的患者长,两组的第1、3年生存率分别为97.4%,73.5%和83.1%,42.8%(P=0.001)。GCB型较非GCB型复发难治DLBCL有明显生存优势,5年生存率分别为42.3%和21.4%(P=0.005)。结论利妥昔单抗联合挽救化疗治疗DLBCL的疗效较好,不良反应可以耐受,结果与文献报道相似。Objective To investigate the efficacy and toxicity of rituximab-based salvage chemotherapy in the treatment of relapsed or refractory diffuse large B-cell lymphoma （DLBCL）.Methods Sixty-nine patients with relapsed or refratory DLBCL were treated by rituximab-based salvage chemotherapy,including 40 male and 29 female patients with a median age of 51.5 years （range 17 to 82 years）.All the patients had prior treatments including of EPOCH,ICE,DHAP,GEMOX,and GDP.Twenty-seven patients also received rituximab treatment as the first-line regimen.Result The objective response （OR） rate was 73.4% （47/64） in these patients with a complete response （CR） rate of 45.3%.The major adverse effects included bone marrow suppression,fatigue,and gastrointestinal toxicity.The side effects of rituximab were mild,including chill,fever and fatigue.The median follow-up was 40.6 （3.7-179.9） months.Twenty-eight patients died of tumor progression and two died from grade 4 myelosuppression accompanied by severe systemic infection.The median survival was 51.6 （3.7-179.9） months in this group.The 1,3 and 5-year overall survival was 92%,62% and 37%,respectively,and in patients without rituximab as the first line treatment,the overall survival at 1 and 3 years （97.4% and 73.5%） was much better than that in rituximab-treated patients （83.1% and 42.8%） （P=0.001）.The patients of GCB subtype had better survival compared to the non-GCB subtype,with the 5-year overall survival of 42.3% and 21.4%,respectively （P=0.005）.Conclusion Rituximab-based salvage regimens are effective and well tolerable,but further clinical trial is warranted.

关 键 词：非霍奇金淋巴瘤 利妥昔单抗 挽救化疗 

分 类 号：R733.1[医药卫生—肿瘤]