利妥昔单抗联合化疗治疗慢性淋巴细胞白血病的疗效分析  

Efficacy of Rituximab for Patients with Chronic Lymphocytic Leukemia

作　　者：李姮[1] 熊文婕[1] 刘慧敏[1] 易树华[1] 吕瑞[1] 王婷玉[1] 于珍[1] 邱录贵[1] 李增军[1] 

机构地区：[1]中国医学科学院北京协和医学院血液学研究所血液病医院实验血液学国家重点实验室,天津300020

出　　处：《中国医学科学院学报》2017年第6期800-805,共6页Acta Academiae Medicinae Sinicae

基　　金：天津市应用基础与前沿技术研究计划(15JCYBJC27900)~~

摘　　要：目的探讨利妥昔单抗在慢性淋巴细胞白血病(CLL)患者中的疗效。方法回顾性分析本院一线应用氟达拉滨+环磷酰胺±利妥昔单抗方案或环磷酰胺+长春新碱+泼尼松±蒽环类药物±利妥昔单抗方案治疗的CLL患者病例资料,比较利妥昔单抗及不同化疗方案的疗效。结果一线采用含利妥昔单抗方案治疗的患者为72例(43.6%);不含利妥昔单抗方案治疗的患者为93例(56.4%)。利妥昔单抗治疗组完全缓解(CR)率和总体反应率(ORR)均显著高于未应用利妥昔单抗治疗组(38.9%比21.5%,P=0.015;83.3%比60.2%,P=0.001)。利妥昔单抗治疗组中位无进展生存期(PFS)为53.0(27.0~79.0)个月,中位总生存时间(OS)为112.0(81.1~142.9)个月,而未应用利妥昔单抗治疗组中位PFS为28.0(18.3~37.7)个月(P=0.094),中位OS为89.0(72.0~106.0)个月(P=0.109),两组比较差异无统计学意义。按是否伴有高危遗传学因素(伴17p缺失或11q缺失)将患者分成高危组和非高危组,高危组联合利妥昔单抗治疗患者可显著提高ORR(86.4%比53.3%,P=0.012),但PFS[14.5(7.9~21.1)个月比20.5(10.7~30.3)个月,P=0.699]及OS[96.0(55.3~136.7)个月比74.0(48.0~100.0)个月,P=0.366]无优势;而在非高危组中,应用利妥昔单抗后患者PFS有延长趋势[71.0(55.3~86.7)个月比38.5(17.7~59.3)个月],但差异无统计学意义(P=0.050)。结论 CLL患者应用利妥昔单抗联合化疗可获得更高的CR率、ORR,并对不伴染色体17p缺失或11q缺失患者的PFS有改善趋势。Objective To evaluate the efficacy of rituximab in treating chronic lymphocytic leukemia（CLL）.Methods The clinical data of CLL patients receiving fludarabine,cyclophosphamide±rituximab（with or without rituximab） regimen or cyclophosphamide,vincristine,and prednisone ±doxorubicin ±rituximab regimen in our hospital from March 2000 to February 2015 were analyzed retrospectively.Therapeutic efficacies and survivals of patients treated with different regimens were evaluated and compared.Results The complete response（CR）rate and the overall response rate（ORR） in 72 patients（43.6%） treated with rituximab were significantly higherthan those treated without rituximab（38.9% vs.21.5%,P=0.015;83.3% vs.60.2%,P=0.001）.The median PFS and OS for patients treated with rituximab were 53.0（27.0-79.0） months and 112.0（81.1-142.9）months,and the median PFS and OS for patients treated without rituximab were 28.0（18.3-37.7） months and 89.0（72.0-106.0）,but the results were not statistically significant（P=0.094,P=0.109）.According to the cytogenetic features,patients were further divided into high-risk subgroup（with chromosome 17 p deletion or 11 q deletion） and non-high-risk subgroup.And in the high-risk subgroup,the ORR of patients treated with rituximab was 86.4%,which was significantly higher than that in patients treated without rituximab（53.3%）（P=0.012）;in the non-high-risk subgroup,the PFS was marginally prolonged in patients treated with rituximab,but the difference was not statistically significant（P=0.050）.Conclusions Compared with traditional chemotherapy,the chemoimmunotherapies with rituximab result in higher CR rate and ORR in CLL patients.In patients without 17 p deletion or 11 q deletion,the use of rituximab can marginally prolong PFS.

关 键 词：慢性淋巴细胞白血病 利妥昔单抗 抗肿瘤联合化疗 预后 

分 类 号：R733.72[医药卫生—肿瘤] R557.4[医药卫生—临床医学]