重组人粒-巨噬细胞集落刺激因子联合R-CHOP方案治疗初治弥漫大B细胞淋巴瘤效果观察  

Efficacy observation of recombinant human granulocyte macrophage stimulating factor combined with R-CHOP regimen in treatment of diffuse large B-cell lymphoma

作　　者：高苏 陈莉[1] 陈洁[1] 章卫平[1] 倪雄[1] 杨建民[1] Gao Su;Chen Li;Chen Jie;Zhang Weiping;Ni Xiong;Yang Jianmin(Department of Hematology,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院血液科,上海200433

出　　处：《白血病．淋巴瘤》2021年第12期730-734,共5页Journal of Leukemia & Lymphoma

基　　金：上海市科委医学引导项目(18411968100)。

摘　　要：目的观察重组人粒-巨噬细胞集落刺激因子(rhGM-CSF)联合R-CHOP方案治疗初治弥漫大B细胞淋巴瘤的临床效果及安全性。方法回顾性分析2017年2月至2019年11月海军军医大学(第二军医大学)长海医院39例接受rhGM-CSF联合R-CHOP方案及39例接受R-CHOP方案治疗的初治DLBCL患者的临床资料,比较两组患者的总反应率(ORR)、完全缓解(CR)率、总生存(OS)、无进展生存(PFS)及不良反应发生情况。结果rhGM-CSF联合R-CHOP方案组及R-CHOP方案组的ORR分别为87.2%(34/39)、82.1%(32/39),差异无统计学意义(χ^(2)=0.394,P=0.53),CR率分别为71.8%(28/39)、56.4%(22/39),差异亦无统计学意义(χ^(2)=2.006,P=0.157)。随访截至2020年9月19日,rhGM-CSF联合R-CHOP方案组生存32例,死亡7例,其中1例死于肠癌,原发病仍处于CR状态;R-CHOP方案组生存32例,死亡7例。rhGM-CSF联合R-CHOP方案组及R-CHOP方案组2年OS率分别为82.5%、73.9%(χ^(2)=0.038,P=0.845),2年PFS率分别为67.1%、55.2%(χ^(2)=0.457,P=0.499)。亚组分析结果显示,rhGM-CSF联合R-CHOP方案组及R-CHOP方案组的生发中心B细胞型亚组间、非生发中心B细胞型亚组间、Lugano分期Ⅰ~Ⅱ期亚组间、Lugano分期Ⅲ~Ⅳ期亚组间、年龄<60岁亚组间、年龄≥60岁亚组间CR率分别比较,差异均无统计学意义(均P>0.05)。主要不良反应为骨髓抑制及其所致感染,两组3~4级血液学不良反应及感染发生率比较,差异均无统计学意义(均P>0.05)。予支持治疗后,所有患者均安全度过骨髓抑制期,无治疗相关死亡。结论rhGM-CSF联合R-CHOP方案用于初治DLBCL患者安全有效。Objective To observe the clinical efficacy and safety of recombinant human granulocyte macrophage stimulating factor(rhGM-CSF)combined with R-CHOP regimen in treatment of diffuse large B-cell lymphoma(DLBCL).Methods The clinical data of 39 patients with newly diagnosed DLBCL treated with rhGM-CSF combined with R-CHOP regimen,and 39 patients with newly diagnosed DLBCL treated with R-CHOP regimen in Naval Medical University(Changhai Hospital)from February 2017 to November 2019 were retrospectively analyzed.The total response rate(ORR),remission rate(CR)rate,overall survival(OS),progression-free survival(PFS)and adverse reactions of both groups were compared.Results In rhGM-CSF combined with R-CHOP regimen group and R-CHOP regimen group,ORR was 87.2%(34/39)and 82.1%(32/39),respectively,and the difference was statistically significant(χ^(2)=0.394,P=0.53);CR rate was 71.8%(28/39)and 56.4%(22/39),respectively,and the difference was statistically significant(χ^(2)=2.006,P=0.157).Until the last follow up on September 19,2020,32 patients survived and 7 patients died in rhGM-CSF combined with R-CHOP regimen group,of which 1 case died of bowel cancer,and the primary disease was still in CR.In the R-CHOP regimen group,32 survived and 7 died.The 2-year OS rates of the two groups were 82.5%and 73.9%,respectively(χ^(2)=0.038,P=0.845);the 2-year PFS rates of the two groups were 67.1%and 55.2%,respectively(χ^(2)=0.457,P=0.499).Subgroup analysis results showed that there were no statistically significant differences in CR rates among germinal center B-cell(GCB)and non-GCB subgroups,Lugano stageⅠ-Ⅱand Lugano stageⅢ-Ⅳsubgroups,aged<60 years and aged≥60 years subgroups in rhGM-CSF combined with R-CHOP regimen group and R-CHOP regimen group(all P>0.05).The major adverse reactions included bone marrow suppression and its inducible infections.There were no significant differences in the incidence of grade 3-4 hematological adverse reactions and infections between the two groups(all P>0.05).All patients safely went through

关 键 词：淋巴瘤 大B-细胞 弥漫性 重组人粒巨噬细胞刺激因子 利妥昔单抗 

分 类 号：R733.1[医药卫生—肿瘤]