二线方案联合利妥昔单抗治疗复发或难治性非霍奇金淋巴瘤的疗效观察  

Curative effects of second-line regimen combined with rituximab in treatment of relapsed or refractory non-Hodgkin lymphoma

作　　者：高飞[1] 杜明珠[1] 李光[1] 边思倩 王浩[1] 刘锋[1] 宋艳萍[1] Gao Fei;Du Mingzhu;Li Guang;Bian Siqian;Wang Hao;Liu Feng;Song Yan-ping(Department of Hemntology,Xi'an Central Hospital,Xi'an Institute of Hematology,Xi'an 710003,China)

机构地区：[1]西安市中心医院血液科西安市血液病研究所,710003

出　　处：《国际肿瘤学杂志》2018年第10期610-614,共5页Journal of International Oncology

基　　金：陕西省自然科学基础研究计划(2013JM4016).

摘　　要：目的探讨含吉西他滨的二线化疗方案联合利妥昔单抗治疗复发或难治性B细胞性非霍奇金淋巴瘤(NHL)的临床疗效、安全性和预后因素。方法选取西安市中心医院2008年7月至2015年2月收治的157例复发或难治性B细胞性NHL患者,其中87例患者采用GEMOX方案(吉西他滨+奥沙利铂)联合利妥昔单抗化疗,70例患者采用GDP方案(吉西他滨+顺铂+地塞米松)联合利妥昔单抗化疗,评价两组化疗疗效。依据既往是否应用过利妥昔单抗对患者进行分组(n=52,n=105),对比分析两组总有效率(ORR)。分析影响患者总生存(OS)的相关预后因素,并观察治疗后患者的不良反应。结果GEMOX方案联合利妥昔单抗组和GDP方案联合利妥昔单抗组的ORR分别为65.5%和55.7%,差异无统计学意义(χ^2=1.58,P=0.210)。52例既往应用过利妥昔单抗的患者ORR为32.7%,105例既往未应用过利妥昔单抗的患者ORR为75.2%,差异有统计学意义(χ^2=29.50,P<0.001)。单因素分析结果显示,淋巴瘤国际预后指数(IPI)评分中高危或高危(χ^2=69.21,P<0.001)、乳酸脱氢酶升高(χ^2=16.90,P<0.001)、难治性患者(χ^2=14.43,P=0.001)、大包块(χ^2=4.57,P=0.030)、挽救性化疗疗效(χ^2=50.85,P<0.001)为影响患者OS的危险因素。Cox多因素分析显示,IPI评分中高危或高危(HR=2.138,95%CI为1.301~3.512,P=0.001)、难治性患者(HR=3.157,95% CI为1.001~10.644,P=0.014)、挽救性化疗后未达CR或PR(HR=3.017,95%CI为2.218~7.366,P<0.001)、乳酸脱氢酶升高(HR=2.236,95%CI为1.797~2.781,P=0.001)、大包块患者(HR=1.792;95%CI为1.255~2.558,P<0.001)为影响患者OS的独立危险因素。化疗不良反应为中性粒细胞减少、血小板减少、恶心呕吐、肝损害以及心脏毒性,无治疗相关性死亡。结论含吉西他滨的二线化疗方案联合利妥昔单抗治疗复发或难治性B细胞性NHL疗效较好,安全性好。IPI评分中高危或高危、难治性患者、挽救性化疗后未达CR或PR、乳酸脱氢酶�Objective To investigate the clinical efficiency, safety and prognostic factors of second-line chemotherapy regimen with gemcitabine combined with rituximab in the treatment of relapsed or refractory B-cell non-Hodgkin lymphoma.Methods A total of 157 patients with relapsed or refractory B-cell non-Hodgkin lymphoma were selected from July 2008 to February 2015 in Xi′an Central Hospital. Among them, 87 patients were given GEMOX regimen (gemcitabine + oxaliplatin) combined with rituximab, and 70 patients were given GDP program (gemcitabine + cisplatin + dexamethasone) combined with rituximab. The chemotherapy efficacies of the two groups were evaluated. At the same time, the patients were grouped according to whether rituximab was applied or not, and the total objective response rate (ORR) difference was compared. The relevant prognostic factors affecting overall survival (OS) were found. The adverse reactions of patients after treatment were observed.Results The ORR of the GEMOX regimen combined with rituximab group was 65.5%, and the ORR of the GDP regimen combined with rituximab group was 55.7%, but the difference between the two groups was not statistically significant (χ^2=1.58, P=0.210). The ORR was 75.2% in 105 patients who had not used rituximab, and the ORR was 32.7% in 52 patients who had previously received rituximab. The difference between the two groups was statistically significant (χ^2=29.50, P<0.001). Uni-variate analysis showed that middle-high risk or high risk of the lymphoma international prognostic index (IPI) score (χ^2=69.21, P<0.001), lactate dehydrogenase (LDH) increased (χ^2=16.90, P<0.001), refractory patients (χ^2=14.43, P=0.001), large mass (χ^2=4.57, P=0.030), and failure to achieve CR or PR after salvage chemotherapy (χ^2=50.85, P<0.001) were risk factors for OS. Cox multivariate analysis showed that middle-high risk or high risk of IPI (HR=2.138, 95%CI: 1.301-3.512, P=0.001), refractory patients (HR=3.157, 95%CI: 1.001-10.644, P=0.014), failure to achieve CR or PR after salva

关 键 词：淋巴瘤 非霍奇金 预后 利妥昔单抗 吉西他滨 

分 类 号：R733.1[医药卫生—肿瘤]