R-GemOx与RICE方案二线治疗复发或难治性弥漫大B细胞淋巴瘤的临床对比研究  

Comparative Study of R-GemOx and RICE Regimens as Second-line Treatments for Refractory or Relapsed DLBCL

作　　者：张会来[1] 王华庆[1] 付凯[1] 侯芸[1] 李维[1] 周世勇[1] 邱立华[1] 钱正子[1] 刘贤明[1] 

机构地区：[1]天津医科大学附属肿瘤医院淋巴肿瘤科,中美淋巴血液肿瘤诊治中心,天津市肿瘤防治重点实验室,天津市300060

出　　处：《中国肿瘤临床》2011年第18期1107-1110,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:对比美罗华联合奥沙利铂和吉西他滨(R-GemOx)与RICE方案二线治疗复发或难治性的弥漫大B细胞淋巴瘤(DLBCL)的疗效及毒副作用。方法:选取复发或难治性弥漫大B细胞淋巴瘤患者65例,随机分为两组,分别接受R-GemOx方案和RICE方案化疗。R-GemOx组方案为:美罗华,375 mg/m^2静脉滴注,d0,吉西他滨(GEM)1 000 mg/m^2,静脉滴注,d1、8;奥沙利铂(L-OHP)130 mg/m^2,静脉滴注,d1;21天为1周期。RICE组方案为:美罗华,375 mg/m^2,静脉滴注,d0;异环磷酰胺(IFO)1 g/m^2,静脉滴注,d1～d3;Mesna解救400mg,静脉滴注q8h,d1～d3;卡铂(CBP),AUC=5,静脉滴注,d2;依托泊苷(VP-16)100mg/m^2,静脉滴注,d1～d3。21天为1个周期。每2周期进行疗效及毒性评价。结果:65例患者中,R-GemOx方案组,完全缓解(CR)4例(12.5%),部分缓解(PR)17例(53.1%),稳定(SD)6例,进展(PD)5例,总有效率(CR+PR)为65.6%,临床获益率(CR+PR+SD)达到84.4%。RICE组CR 4例(12.1%),PR 16例(48.5%),SD 7例,PD 6例,总有效率60.6%,临床获益率81.8%两组的不良反应主要为骨髓抑制,其中R-GemOx组白细胞下降Ⅲ度5例,Ⅳ度2例;贫血Ⅲ度2例;血小板下降Ⅲ度4例,Ⅳ度2例。RICE组白细胞下降Ⅲ度16例,Ⅳ度5例;贫血Ⅲ度2例;血小板下降Ⅲ度5例,Ⅳ度3例。胃肠道反应RICE组较R-GemOx组为重,其中Ⅲ度2例,Ⅳ度1例。比较两组毒副反应,R-GemOx组在中性粒细胞减少,消化道反应方面明显好于RICE组(P<0.05)。而RICE组未出现一例末梢神经毒性。结论:R-GemOx方案是二线治疗复发或难治性弥漫大B细胞淋巴瘤较为安全且有效的化疗方案,其远期疗效尚需进一步观察。Objective： To compare the efficacy and safety of R-GemOx and RICE regimens for treating relapsed or refractory non-Hodgkin＇s lymphoma （NHL）. Methods： Up to 65 cases with relapsed and refractory diffuse large B cell lymphoma （DLBCL） were randomly divided into two groups. These patients received R-GemOx and RICE regime, respectively. The R-GemOx regimen included rituximab at 375 mg/m：, ivd, dO; GEM at 1000 mg/m2, ivd, dl, 8; and L-OHP at 130 mg/m2, ivd, dl at 21 days per cycle. The RICE reg/me included rituximad at 375 mg/m2, ivd, dO; IFO at 1 g/m2, ivd, dl-d3; Mesna at 400 mg, ivd q8h, dl-d3; CBP AUC - 5, ivd, d2; and Vp-16 at 100 mg/m2, ivd, dl-d3 at 21 days per cycle. Their efficacy and safety were evaluated every two weeks. Results： For the R-Ge- mOx group, complete remission （ CR ） was achieved in 4 cases （ 12.5% ）, partial remission （ PR ） in 17 cases （ 53.1% ）, stable disease （ SD ） in 6 cases, and progressive disease （ PD ） in 5 cases. The overall response rate （ CR＋PR ） was 65.6%, and the clinical benefit rate （ CR＋PR＋ SD ） was 84.4%. For the RICE group, CR was achieved in 4 cases （ 12.1% ）, PR in 16 cases （ 48.5% ）, SD in 7 cases, and PD in 6 cases. The overall response rate （ CR＋PR ） was 60.6%, and the clinical benefit rate （ CR＋PR＋ SD ） was 81.8%. The main side ef- fect was bone marrow suppression. In the R-GemOx group, leukopenia was observed with 5 cases at grade Ⅲ and 2 cases at grade IV; anemia was observed with 2 cases at grade Ⅲ; thrombocytopenia was observed with 5 cases at grade Ⅲ and 3 cases at grade IV. In the RICE group, leukopenia was observed with 16 cases at grade Ⅲ and 5 cases at grade Ⅳ; anemia was observed with 2 cases at grade Ⅲ; thrombocytopenia was observed with 5 cases at grade Ⅲ and 3 cases at grade Ⅳ. The gastrointestinal tract reaction in the RICE group was more serious than in the R-GemOx group： 2 cases at grade Ⅲ and 1 case at grade IV. Comparison of the side effects in the two gro

关 键 词：弥漫大B细胞淋巴瘤 美罗华 吉西他滨 奥沙利铂 

分 类 号：R733.1[医药卫生—肿瘤]