脂质体阿霉素与表柔比星在弥漫大B细胞淋巴瘤一线治疗中的比较  

Comparison of liposomal Doxorubicin and Epirubicin in the treatment of diffuse large B-cell lymphoma

作　　者：余海峰 彭帅羚 陈曦 韩水云 胡涵光[1] Yu Haifeng;Peng Shuailing;Chen Xi;Han Shuiyun;Hu Hanguang(Department of Lymphatic Medical Oncology,The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Institute of Basic Medicine and Cancer,Chinese Academy of Sciences,Hangzhou 310022,China;Department of Medical Oncology,Key Laboratory of Cancer Prevention and Intervention,Ministry of Education,The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院肿瘤内科,杭州310009 [2]中国科学院大学附属肿瘤医院,浙江省肿瘤医院淋巴肿瘤内科,杭州310022

出　　处：《中华老年医学杂志》2022年第6期678-683,共6页Chinese Journal of Geriatrics

基　　金：浙江省自然科学基金资助项目(LY19C080001,LY19C080002)。

摘　　要：目的比较脂质体阿霉素(PLD)与表柔比星(EPI)在弥漫大B细胞淋巴瘤(DLBCL)一线治疗中的有效性和安全性。方法回顾性地收集整理在浙江省肿瘤医院就诊的DLBCL患者临床资料,就诊时间从2013年3月至2018年4月,共纳入411例接受过一线化疗的患者。根据年龄、性别、淋巴瘤分期等因素,采用倾向评分匹配(PSM)法1∶1配对,选出PLD组和EPI组患者各151例。进而对比PLD组和EPI组的有效性和不良事件。所有患者在治疗后随访3年,观察生存情况。结果PLD组完全缓解(CR)率81.5%,EPI组CR率72.2%。PLD组客观缓解率(ORR)98%,EPI组ORR 96.7%。两组CR率(χ^(2)=0.478,P=0.489)及ORR的差异(χ^(2)=0.007,P=0.934)均无统计学意义。PLD组发生骨髓抑制25例(16.6%),发生心脏毒性相关事件21例(13.9%);EPI组发生骨髓抑制和心脏毒性相关事件均为24例(15.9%),两组的骨髓抑制差异(χ^(2)=0.018,P=0.895)和心脏毒性差异(χ^(2)=0.174,P=0.677)均无统计学意义。3年随访中,PLD组和EPI组的无进展生存期(PFS)分别为79.1%和69.6%,两组差异有统计学意义(χ^(2)=3.930,P=0.047)。PLD组和EPI组的3年总生存率(OS)都为85.2%,两组差异无统计学意义(χ^(2)=0.402,P=0.538)。结论PLD在DLBCL患者一线化疗中的3年无进展生存期显著优于EPI,而在3年总生存期、短期疗效和骨髓抑制上与EPI相当。Objective To compare the efficacy and safety of pegylated liposomal Doxorubicin(PLD)and Epirubicin(EPI)as first-line chemotherapy for diffuse large B-cell lymphoma(DLBCL).Methods Clinical data of DLBCL patients treated at Zhejiang Cancer Hospital from March 2013 to April 2018 were retrospectively collected.A total of 411 patients who had received first-line chemotherapy were included.Based on age,sex,Ann Arbor staging and other parameters and using the PSM method for 1∶1 matching,151 patients were assigned into each of the PLD group and the EPI group.Efficacy and adverse events were compared between the PLD group and the EPI group.All patients were followed up for 3 years after treatment to monitor survival.Results The complete response(CR)rate in the PLD group was 81.5%,and the CR rate in the EPI group was 72.2%.The objective response rate(ORR)of the PLD group was 98%,and the ORR of the EPI group was 96.7%.There was no significant difference in CR rate(χ^(2)=0.478,P=0.489)or ORR between the two groups(χ^(2)=0.007,P=0.934).In the PLD group,myelosuppression occurred in 25 cases(16.6%)and cardiotoxicity-related events in 21 cases(13.9%);in the EPI group,there were 24 cases(15.9%)of myelosuppression and the same number of cases of cardiotoxicity-related events,and there were no significant differences in myelosuppression(χ2=0.018,P=0.895)or cardiotoxicity(χ^(2)=0.174,P=0.677)between the two groups.During the 3-year follow-up,the progression free survival(PFS)rates of the PLD group and the EPI group were 79.1%and 69.6%,respectively,with a statistically significant difference between the two groups(χ^(2)=3.930,P=0.047).Both the PLD group and the EPI group had a 3-year OS rate of 85.2%,with no statistically significant difference between the two groups(χ^(2)=0.402,P=0.538).Conclusions The 3-year progression-free survival of DLBCL patients with PLD as first-line chemotherapy is significantly better than with EPI,and the 3-year overall survival,short-term efficacy and myelosuppression are comparable to those with

关 键 词：表柔比星 脂质体阿霉素 淋巴瘤 大B细胞 弥漫性 抗肿瘤联合化疗 

分 类 号：R733.1[医药卫生—肿瘤]