R-CDOP方案在初治弥漫大B细胞淋巴瘤的疗效分析  

Therapeutic efficacy of R-CDOP regimen for diffusive large B-cell lymphoma

作　　者：陈丽萍 刘玄勇 贤晓敏 谢晶 蓝晓凤 庄佳玲 王月乔 王强[1] 郭智 CHEN Li-ping;LIU Xuan-yong;XIAN Xiao-min;XIE Jing;LAN Xiao-feng;ZHUANGJia-ling;WANG Yue-qiao;WANG Qiang;GUO Zhi(College of Medical,Wuhan University of Science and Technology,Wuhan 430065;National Cancer Center/National Clinical Research Cancer for Cancer/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen Guangdong 518116)

机构地区：[1]武汉科技大学医学院,武汉430065 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院,广东深圳518116

出　　处：《中南药学》2022年第7期1515-1520,共6页Central South Pharmacy

基　　金：吴阶平医学基金项目(No.32067502020-10-17);深圳市“医疗卫生三名工程”项目(No.SZSM201612085)。

摘　　要：目的评价R-CDOP方案(利妥昔单抗+环磷酰胺+聚乙二醇脂质体阿霉素+长春新碱+泼尼松)在初治弥漫大B细胞淋巴瘤(DLBCL)中的有效性及安全性。方法回顾性分析某院血液肿瘤科于2018年1月至2021年12月收治的111例初治的DLBCL患者的临床资料,中位年龄52岁(21~80岁),R-CDOP方案化疗(R-CDOP组)80例,同期使用R-CHOP方案(利妥昔单抗+环磷酰胺+吡柔比星+长春新碱+泼尼松)化疗(R-CHOP组)31例,主要研究终点是客观缓解率、无进展生存时间;次要研究终点是一般不良反应以及心脏毒性。结果R-CDOP组和R-CHOP组患者的客观缓解率分别为92.5%和83.9%(P=0.312);R-CDOP组和R-CHOP组患者的中位无进展生存时间分别为36个月和24个月(P=0.111);但亚组分析显示在IPI评分≥3分、肿块≥7.5 cm的患者中,R-CDOP组较R-CHOP组可看到一定的疗效优势,中位无进展生存时间分别为30.6个月和16.0个月(P=0.039)、33.7个月和11.5个月(P=0.027)。主要毒副反应(血液毒性、胃肠道反应、肝功能损伤)两组相近;心脏毒性的发生率R-CDOP组较R-CHOP组更少(17.5%vs 48.3%,P<0.001)。结论在总体DLBCL人群中,R-CDOP方案与R-CHOP方案疗效相当,但在心脏毒性方面前者安全性更高。同时,对于IPI评分≥3分、大包块的DLBCL患者,R-CDOP方案也显示出了一定的无进展生存时间获益优势。Objective To evaluate the efficacy and safety of R-CDOP regimen(rituximab+cyclophosphamide+pegylated liposomal adriamycin+vincristine+prednisone)for diffusive large B-cell lymphoma(DLBCL).Methods Clinical data of 111 patients with DLBCL were collected retrospectively.The median age was 52(21-80 years old),including 80 patients treated with R-CDOP regimen(the R-CDOP group),and 31 treated with R-CHOP regimen(the R-CHOP group).The primary endpoints included objective response rate(ORR)and progress-free survival(PFS).Secondary endpoints covered adverse events and cardiotoxicity.Results The ORR was 92.5%vs 83.9%for the R-CDOP group and the R-CHOP group,without significant difference in both groups(P=0.312).The median PFS was 36 months vs 24 months for the R-CDOP group and the R-CHOP group(P=0.111).Subgroup analysis showed the median PFS among patients with international prognostic index(IPI)≥3 and large mass(d≥7.5 cm)in the R-CDOP group was better than that in the R-CHOP group.The median PFS was 30.6 months and 16.0 months(P=0.039),vs 33.7 months and 11.5 months(P=0.027).There were no significant differences in the hematological toxicity,nausea,vomit,and abnormal liver function between the two groups.The difference in the incidence of cardiotoxicity was significant between the two groups(P<0.001).Conclusion R-CDOP regimen has similar efficacy as R-CHOP regimen in the overall DLBCL patients,but can reduce cardiotoxicity.In the meanwhile,the R-CDOP regimen shows better efficacy in DLBCL patients at IPI≥3 and with large mass.

关 键 词：聚乙二醇脂质体阿霉素 弥漫大B细胞淋巴瘤 无进展生存时间 心脏毒性 

分 类 号：R96[医药卫生—药理学]