来那度胺治疗复发难治弥漫大B细胞淋巴瘤效果观察  

Efficacy observation of lenalidomide in treatment of relapsed/refractory diffuse large B-cell lymphoma

作　　者：王小艳 宋浩 吴国林 胡茂贵 王翠翠 曹琳琳 丁凯阳 Wang Xiaoyan;Song Hao;Wu Guolin;Hu Maogui;Wang Cuicui;Cao Linlin;Ding Kaiyang(Department of Hematology,Anhui Provincial Hospital Affiliated to Anhui Medical University,Hefei 230001,China;Department of Hematology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院血液科,合肥230001 [2]中国科学技术大学附属第一医院血液科,合肥230001

出　　处：《白血病．淋巴瘤》2022年第7期391-396,共6页Journal of Leukemia & Lymphoma

基　　金：安徽省重点研究与开发计划(1804h08020249);中国抗癌协会淋巴瘤科研基金(CORP-117)。

摘　　要：目的探讨来那度胺联合二线免疫化疗作为挽救方案治疗复发难治弥漫大B细胞淋巴瘤(DLBCL)患者的临床疗效。方法回顾性分析中国科学技术大学附属第一医院2016年1月至2020年12月收治的37例自体造血干细胞移植后复发或不符合移植条件或无移植意愿、接受来那度胺联合二线免疫化疗方案治疗的复发难治DLBCL患者临床资料。其中6例为原发性中枢神经系统淋巴瘤,3例为继发性中枢神经系统淋巴瘤。评估治疗结束后的近期疗效。采用Kaplan-Meier法分析患者总生存(OS)和无进展生存(PFS),亚组间比较采用log-rank检验。结果37例患者中位随访时间为20.4个月(2.7~37.0个月)。治疗结束时,所有患者的总有效率(ORR)为64.9%(24/37),完全缓解(CR)率为45.9%(17/37),24例对治疗有反应患者的中位反应持续时间(DOR)为17.7个月(3.6~33.6个月)。所有患者的中位PFS时间为11.2个月,1年PFS率为48.6%(95%CI 32.5%~64.7%)。所有患者的中位OS时间未达到,1年OS率为67.6%(95%CI 52.5%~82.7%)。在24例对治疗有反应的患者中,与7例缓解后未接受来那度胺维持治疗的患者相比,17例缓解后来那度胺维持治疗患者OS和PFS差异虽均无统计学意义(均P>0.05),但有更好的改善趋势。最常见的不良反应为嗜中性粒细胞降低,发生率为81.1%(30/37)。结论来那度胺联合二线免疫化疗可能是复发难治DLBCL、尤其是中枢神经系统受累患者的有效挽救疗法。经挽救治疗达缓解的患者继续接受来那度胺维持治疗可以改善预后。Objective To explore the clinical efficacy of lenalidomide combined with second-line immunochemotherapy as a salvage regimen in the treatment of relapsed/refractory diffuse large B-cell lymphoma(DLBCL).Methods The clinical data of 37 relapsed/refractory DLBCL patients receiving lenalidomide combined with second-line immunochemotherapy as a salvage regimen who had recurrence after autologous hematopoietic stem cell transplantation or who were not eligible for transplantation or had no intention to transplant between January 2016 and December 2020 in the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed.Among 37 patients,6 cases with primary central nervous system(CNS)lymphoma and 3 cases with secondary CNS lymphoma.The short-term efficacy after treatment was evaluated.Kaplan-Meier method was used to analyze the overall survival(OS)and progression-free survival(PFS),and log-rank test was used for subgroup comparison.Results The median follow-up time of 37 patients was 20.4 months(2.7-37.0 months).At the end of treatment,the overall response rate(ORR)of all patients was 64.9%(24/37),the complete response(CR)rate was 45.9%(17/37),and the median duration of response(DOR)of 24 patients who responded to treatment was 17.7 months(3.6-33.6 months).The median PFS time of all patients was 11.2 months,and the 1-year PFS rate was 48.6%(95%CI 32.5%-64.7%).The median OS time of all patients was not reached,and the 1-year OS was 67.6%(95%CI 52.5%-82.7%).Among 24 responding patients,17 cases who received lenalidomide maintenance therapy after remission tended to have a better response compared with 7 cases who did not receive lenalidomide maintenance therapy after remission,although there was no significant difference in OS and PFS between both groups(both P>0.05).Additionally,neutropenia was the most common adverse reaction with an incidence of 81.1%(30/37).Conclusions Lenalidomide combined with the second-line immunochemotherapy may be an effective salvage therapy for patie

关 键 词：淋巴瘤 大B细胞 弥漫性 挽救疗法 中枢神经系统肿瘤 治疗结果 来那度胺 

分 类 号：R733.1[医药卫生—肿瘤]