摘要
目的 ：CHOP方案是目前治疗弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma,DLBCL）的标准方案。CD20单抗美罗华（rituximab,R）与CHOP方案联合后,R-CHOP方案的治疗效果进一步的提高。本研究着重分析治疗过程中药物的每疗程剂量、时间剂量强度等与治疗结果的关系。方法：回顾性研究经（R）-CHOP方案治疗的DLBCL初诊患者52例。分析国际预后指数（IPI）评分、CHOP方案中的强的松、环磷酰胺和阿霉素的平均每疗程剂量强度（DIPC）和平均每周剂量强度（DIPW）与疗效的关系。结果：病例的中位随诊时间为34个月（6-95个月）,在经Pearson Chi-Square统计后发现,患者起病时的强的松DIPW〈166.7mg/m2、IPI评分、Ann Arbor分期（A或B）可以影响患者的完全缓解（CR）率（均P〈0.05）。在将上述与CR有关的因素进行Logistic回归分析后,发现强的松DIPW〈166.7 mg/m2和IPI积分为与CR相关的独立预后因素（均P〈0.05）。对患者总生存（OS）资料进行Kaplan-Meier分析发现,经Log-rank检验后,IPI积分、阿霉素〈16.7 mg/（m2·周）、环磷酰胺〈250 mg/（m2·周）与DLBCL患者的OS有关。在将上述与OS有关的因素进行Cox regression分析后,发现阿霉素〈16.7 mg/（m2·周）、IPI积分为与OS相关的独立预后因素（P均〈0.05）。结论：对于用（R）-CHOP方案的初诊DLBCL患者,不但起病时的IPI积分、Ann Arbor分期（A或B）等与治疗结果相关,而且治疗因素如环磷酰胺和阿霉素的平均每周剂量强度也影响预后。在治疗过程中,应尽可能地按预定治疗方案给药。
Objective：CHOP is the standard regimen to treat diffuse large B cell lymphoma （DLBCL）. With the anti-CD20 monoclonal antibody（rituximab,R） combined with CHOP regimen,the therapeutic effect of R-CHOP regimen is further improved. To investigate the clinical significances of treatment-related variables for the diffuse large B-cell lymphoma（DLBCL） patients who treated with front- line （R）-CHOP regimen. Methods：This retrospective study evaluated 52 conservative newly diagnosed patients who were treated with （R）-CHOP regimen. The prognostic roles of international prognostic index （IPI）, average dose intensity per cycle （DIPC） and dose intensity per week （DIPW） of cyclophosphamide,doxorubicin,prednisone in （R）-CHOP regimen were evaluated. Results：The median follow-up period of this study was 34 months（from 6 to 95 months）. Pearson Chi-Square analysis showed that complete response（CR） rates were significandy affected by average DIPW of prednisone 〈166.7 mg/m2,IPI scores and Ann Arbor stage（A or B group） （all P 〈 0.05）. When the two factors were subsequently tested by multifactorial Logistic stepwise regression, average DIPW of prednisone 〈 166.7 mg/m2 and IPI scores were again showed to be independent risk factors for CR rate. With regards to OS,it was showed to be significantly affected by IPI scores,average DIPW of cyclophosphamide 〈250 mg/m2 and doxornbicin 〈16.7 mg/m2（all P 〈 0.05）. In the subsequent Cox regression test,only IPI scores and average DIPW of doxorubicin 〈16.7 mg/m2 were showed to be independent prognostic factor for OS rate. Conclusion：In addition to IPI scores and Anna Arbor stage （A or B group） ,average DIPW of doxorubicin was also showed to be an important prognostic factor for the clinical outcome of newly diagnosed DLBCL patients who were first-line treated with （R）-CHOP regimen. It is strongly recommended to strictly adhere to planned （R）-CHOP regimen schedule in every possibility.
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
北大核心
2015年第4期529-533,共5页
Journal of Nanjing Medical University(Natural Sciences)
基金
国家自然科学基金(81202358)
镇江市社会发展项目(SH2011021)
