利妥昔单抗联合DHAX方案与CHOP方案一线治疗老年初诊弥漫大B细胞淋巴瘤的回顾性研究  

A Retrospective Study of R±DHAX Regimen versus R-CHOP Regimen First-Line Treatment of Elderly Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma

作　　者：韦卫萍 余先球[1] 王丽霞[1] 张硕[1] 费小明[1] WEI Wei-Ping;YU Xian-Qiu;WANG Li-Xia;ZHANG Shuo;FEI Xiao-Ming(Department of Hematology,The Affiliated Hospital of Jiangsu University,Zhenjiang 212001,Jiangsu Province,China)

机构地区：[1]江苏大学附属医院血液科,江苏镇江212001

出　　处：《中国实验血液学杂志》2024年第3期718-722,共5页Journal of Experimental Hematology

基　　金：镇江市重点研发计划-社会发展项目(SH2022038)。

摘　　要：目的:探讨R±DHAX方案与R-CHOP方案一线治疗老年初诊弥漫大B细胞淋巴瘤(DLBCL)患者的临床疗效及预后。方法:回顾性分析江苏大学附属医院血液科2011年8月—2021年8月收治并至少完成3疗程的36例老年DLBCL患者,根据治疗方案分为利妥昔单抗±DHAX(R±DHAX)方案组(18例)和利妥昔单抗联合CHOP(R-CHOP)方案组(18例),观察患者的临床特征、疗效及生存。结果:与R-CHOP组比较,R±DHAX组患者更高龄、体能状态更差及IPI评分更高,在年龄、ECOG评分、IPI评分上两组间差异有统计学意义(P=0.005,P=0.018,P=0.035),而在性别、有无B症状、LDH是否升高、有无结外累及、细胞来源、有无骨髓浸润、是否联合使用利妥昔单抗上两组间差异均无统计学意义(P=0.738,P=1,P=0.315,P=0.305,P=0.413,P=0.177,P=0.711,P=0.229)。36例患者均可评价疗效,其中CR 14例(38.9%)、PR 17例(47.2%)、PD 5例(13.9%),ORR为86.1%(31/36)。R±DHAX组和R-CHOP组CR[27.8%(5/18)对50.0%(9/18)]、PR[44.4%(8/18)对50.0%(9/18)]差异无统计学意义,但ORR[72.2%(13/18)对100.0%(18/18)]差异有统计学意义(P=0.045)。R±DHAX组和R-CHOP组1年OS率分别为(38.9±11.5)%和(94.4±7.4)%,2年OS率分别为(16.7±8.8)%和(72.2±10.6)%,组间比较差异有统计学意义(P=0.001,P=0.002)。R±DHAX组中位生存时间11个月(95%CI:8.9-13.1),R-CHOP组中位生存时间未达到,组间存在统计学差异(P<0.001)。结论:对于老年DLBCL患者,在OS方面R±DHAX方案可能不优于R-CHOP方案,且ECOG评分、IPI评分、年龄可能影响老年DLBCL患者生存。但R±DHAX方案安全、可耐受且具有一定疗效,可作为临床上老年DLBCL治疗选择之一。Objective:To investigate the clinical efficacy and prognosis of Rituximab combined with DHAX and CHOP regimen in the first-line treatment of elderly patients with newly diagnosed diffuse large B-cell lymphoma(DLBCL).Methods:A total of 36 elderly patients with DLBCL who were admitted and treated with 3 of more courses of treatment from August 2011 to August 2021 were retrospectively analyzed,and they were divided into rituximab±DHAX(R±DHAX)regimen group(18 cases)and rituximab±CHOP(R-CHOP)regimen group(18 cases)according to the treatment plan,and clinical features,efficacy and survival of the patients were observed.Results:Compared with R-CHOP group,patients of the R±DHAX group were older,and had worse performance status and higher IPI score,the differences between two groups in age,ECOG score and IPI score were statistically significant(P=0.005,P=0.018,P=0.035),but there were no significant differences beween two groups in gender,whether there were B symptoms,whether LDH was elevated,whether there was extranodal involvement,cell origin,bone marrow infiltration,and whether rituximab was combined(P=0.738,P=1,P=0.315,P=0.305,P=0.413,P=0.177,P=0.711,P=0.229).The efficacy could be evaluated in 36 cases,including CR 14(38.9%),PR 17(47.2%),PD 5(13.9%),and ORR of 86.1%(31/36).There were no statistically significant differences in CR[27.8%(5/18)vs 50.0%(9/18);P>0.05]and PR[44.4%(8/18)vs 50.0%(9/18);P>0.05]of R±DHAX group and R-CHOP group,there was statistically significant difference in ORR[72.2%(13/18)vs 100.0%(18/18);P=0.045]between two groups.The 1-year OS of R±DHAX group and R-CHOP group was(38.9±11.5%)%and(94.4±7.4%)%,respectively,2-year OS was(16.7±8.8)%and(72.2±10.6)%,respectively,and the differences between two groups were statistically significant(P=0.001,P=0.002).The median survival time in the R±DHAX group was 11 months(95%CI:8.9-13.1),and the median survival time in the R-CHOP group was not reached,and there was a statistically significant difference between the groups(P<0.001).Conclusion:For elderly

关 键 词：非霍奇金淋巴瘤 老年 临床特征 疗效 预后 

分 类 号：R733.3[医药卫生—肿瘤]