ICE治疗84例复发难治性弥漫大B细胞淋巴瘤的疗效及预后分析  

Efficacy and prognostic analysis of ICE regimen for 84 patients with relapsed/refractory diffuse large B-cell lymphoma

作　　者：赵冰冰[1] 张慕晨 郝杰 刘振宇[3] 熊红[1] 赵维莅[2] 王黎[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院血液科联合病房(徐汇区中心医院),上海200031 [2]上海交通大学医学院附属瑞金医院血液科,上海200025 [3]上海交通大学医学院附属瑞金医院血液科联合病房(北站医院血液科),上海200070

出　　处：《上海交通大学学报（医学版）》2017年第6期752-757,共6页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金(81325003;81520108003;81670716;81201863);上海市杰出青年医学人才培养资助计划;上海市教育委员会高峰高原学科建设计划(20152206;20152208);上海市科学技术委员会项目(14430723400;14140903100;16JC1405800);静安区卫生科研课题(2016MS11);徐汇区中心医院院级科研课题(2014XHYY-04);上海交通大学SMC-晨星青年学者奖励计划~~

摘　　要：目的·研究ICE(异环磷酰胺、卡铂、依托泊苷)方案治疗复发难治性弥漫大B细胞淋巴瘤(DLBCL)患者的有效性及相关预后因素。方法·回顾性分析2004年7月—2016年6月收治的84例初发进展期及复发难治性DLBCL患者的临床资料,给予ICE方案化疗,采用Kaplan-Meier方法计算总生存期,并采用Cox回归方法进行多因素分析。结果·84例患者中26例达完全缓解,11例达部分缓解,客观缓解率为44.0%;获得缓解所需的化疗疗程的中位数为3个(1~6个)。1年总体生存率为49.5%,2年总体生存率为30.0%,中位生存期为12.2个月。单因素分析显示早期复发或进展(P=0.041)、IPI中高危/高危(P=0.024)及NCCN-IPI中高危/高危(P=0.002)是影响患者生存的不良因素,化疗后缓解与延长患者生存显著相关(P=0.000);多因素分析提示NCCN-IPI中高危/高危为影响患者生存的独立危险因素,化疗后缓解为延长患者生存的独立预后指标。结论·ICE方案可作为复发难治性DLBCL患者的有效挽救性治疗方案。Objective · To evaluate the efficacy and prognostic factors of ifosfamide-cisplatin-etoposide （ICE） chemotherapy as salvage regimen for patients with relapsed/refractory diffuse large B-cell lymphoma （DLBCL）. Methods · A retrospective analysis was performed on 84 relapsed/refractory DLBCL patients who were treated with ICE salvage regimen at Ruijin Hospital （Shanghai Jiao Tong University School of Medicine, China） from July 2004 to June 2016. Overall survival （OS） was analyzed by Kaplan-Meier method and multivariate Cox proportional hazards models. Results · Of the 84 patients who were treated with ICE regimen, 37 （44.0%） patients had responses, including 26 （31.0%） achieving complete remission. The median number of cycles per patient was 3 （range 1-6 cycles）. The 1-year and 2-year OS rates were 49.5% and 30.0%, respectively. The median OS time was 12.2 months. On univariate analysis, patients with early progression/recurrence （P=0.041） and a high-intermediate/high risk according to the international prognostic index （IPI） （P=0.024） and NCCN-IPI （P=0.002） had poorer outcomes. While improved outcome was found in patients in complete remission after chemotherapy （P=0.000）. The multivariate analysis revealed that the intermediate-high/high risk according to NCCN-IPI was an independent risk factor, and remission after chemotherapy was an independent prognostic factor for prolonging survival. Conclusion · The ICE regimen can be used as an effective salvage therapy for patients with relapsed/refractory DLBCL.

关 键 词：复发难治性弥漫大B细胞淋巴瘤 预后 挽救治疗 ICE方案 

分 类 号：R733.1[医药卫生—肿瘤]