利妥昔单抗联合化学治疗方案诱导治疗初治边缘区淋巴瘤的疗效  

Efficacy of rituximab combined with chemotherapy in induction remission of de-novo marginal-zone lymphoma

作　　者：陆海洋 张莉[1] 郑重[1] 许彭鹏[1] 赵维莅[1] LU Haiyang;ZHANG Li;ZHENG Zhong;XU Pengpeng;ZHAO Weili(Shanghai Institute of Hematology,State Key Laboratory of Medical Genomics,National Research Center for Translational Medicine at Shanghai,Department of Hematology,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院血液科,上海血液学研究所,医学基因组学国家重点实验室,转化医学国家重大科技基础设施(上海),上海200025

出　　处：《上海医学》2023年第7期477-482,共6页Shanghai Medical Journal

基　　金：上海市科学技术委员会生物医药重点应用研究项目(08411953900)。

摘　　要：目的分析利妥昔单抗联合化学治疗(简称化疗)方案治疗初治边缘区淋巴瘤(MZL)的疗效,为优化治疗方案的选择提供依据。方法选择2020年1月—2022年6月间,就诊于上海交通大学医学院附属瑞金医院血液科的具有化疗指征的初治MZL患者共45例,分别接受利妥昔单抗联合苯达莫司汀(BR组,25例)或利妥昔单抗联合来那度胺(R2组,20例)进行诱导治疗。参照非霍奇金淋巴瘤Lugano标准进行疗效的中期评估和末期评估。采用Wilcoxon检验、卡方检验或Fisher确切概率法比较两组间患者一般情况,中期和末期评估时两组间总反应率(ORR)、完全缓解率(CRR),以及不同病理亚型、不同危险度间两组间ORR、CRR。结果R2组女性占比显著高于BR组(P=0.045)。中期、末期评估时,两组间ORR、CRR的差异均无统计学意义(P值均>0.05)。按不同病理亚型区分,中期、末期评估时结外边缘区淋巴瘤(EMZL)与非EMZL患者两组间ORR、CRR的差异均无统计学意义(P值均>0.05)。按不同危险度区分,中期评估时,中危患者两组间ORR、CRR的差异无统计学意义(P值均>0.05),高危患者两组间ORR的差异无统计学意义(P>0.05),而R2组的CRR显著高于BR组(P=0.026);末期评估时,中危、高危患者两组间ORR、CRR的差异均无统计学意义(P值均>0.05)。中期评估为未缓解/疾病稳定的7例患者中,R2组3例更换为BR方案,1例更换为R-CHOP方案治疗,R2组余1例和BR组2例继续原方案治疗,末期评估BR组ORR为1/2,R2组为5/5。结论R2方案与BR方案疗效相当,R2方案对高危患者获得完全缓解具有显著优势。Objective To analyze the efficacy of rituximab combined with chemotherapy in induction remission of de-novo marginal-zone lymphoma(MZL),and provide a basis for optimizing the selection of treatment plans.Methods A total of 45 newly treated MZL patients with systemic treatment indications who were treated in the Department of Hematology of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2020 to June 2022 were enrolled in this study.They received induction treatment with rituximab combined with bendamustatin(BR group,n=25)or rituximab combined with lenalidomide(R2 group,n=20).Mid-term and final assessments were performed according to the Lugano criteria for non-Hodgkin lymphoma.The general condition,total response rate(ORR)and complete response rate(CRR)at mid-term and final assessments were compared between the two groups.Results The proportion of women in the R2 group was significantly higher than that in the BR group(P=0.045).At the mid-term and final assessments,there was no significant difference in ORR or CRR between the two groups(all P>0.05).According to pathological results,the patients were divided into extranodal marginal zone lymphoma(EMZL)subgroup and non EMZL subgroup.At the mid-term and final assessments,there was no significant difference in ORR or CRR between R2 group and BR group either in EMZL patients or non-EMZL patients(all P>0.05).At the mid-term evaluation,there was no significant difference in ORR or CRR between the two groups of medium-risk patients(all P>0.05),and there was no significant difference in ORR between the two groups of high-risk patients(P>0.05),but the CRR of the R2 group was significantly higher than that of the BR group(P=0.026).At the final evaluation,there was no significant difference in ORR or CRR between the two groups of medium and high-risk patients(all P>0.05).Among the 7 non-remission(NR)/stable disease(SD)patients at the mid-term assessment,BR regimen was continued in 2 patients,R2 regimen was continued in 1 patient,R2

关 键 词：边缘区淋巴瘤 诱导治疗 免疫化学治疗 化学治疗 

分 类 号：R733.4[医药卫生—肿瘤]