摘要
目的]评价利妥昔单抗联合化疗在老年原发性中枢神经系统淋巴瘤（PCNSL）中的治疗效果。[方法]2010年10月至2013年10月收治的PCNSL患者91例,随机分为利妥昔单抗联合化疗组（R-MAD组）（n=31）给予利妥昔单抗375mg/m2、大剂量甲氨蝶呤3.5g/m2、阿糖胞苷0.5-1.0g/m2及地塞米松10mg/d治疗;靶向治疗组（n=30）采用大剂量甲氨喋呤3.5g/m2联合利妥昔单抗375mg/m2联合化疗;传统治疗组（n=31）采用全脑放疗加大剂量甲氨喋呤3.5g/m2治疗。比较各组疗效、不良反应、1年和3年生存率。[结果]（1）R-MAD组、靶向治疗组及传统治疗组完全缓解率分别为54.84%、33.33%和16.67%（χ2=10.856,P=0.004）;总有效率分别为83.87%、66.67%和53.33%（χ2=6.592,P=0.037）。（2）R-MAD组的血液系统、肝脏毒性、胃肠道反应及神经毒性不良反应的发生率明显低于传统治疗组（P〈0.05）,R-MAD组的骨髓抑制发生率明显高于靶向治疗组及传统治疗组（P〈0.05）。（3）R-MAD组1年和3年的生存率高于靶向治疗组和传统治疗组（χ2=7.715、8.139,P=0.021、0.017）。[结论]利妥昔单抗、大剂量甲氨蝶呤、阿糖胞苷及地塞米松联合应用治疗老年PCNSL可提高治疗效果,延长患者的生存时间,但不增加不良反应。
[Purpose]To assess the efficacy of rituximab combined with chemotherapy regimen in treatment of elderly patients with primary central nervous system lymphomas（PCNSL）.[Methods]Ninety one elderly patients with PCNSL admitted in our hospital from October 2010 to October 2013 were divided into three groups randomly.Patients in R-MAD group（n=31）received rituximab（375mg/m2）,highdose methotrexate（3.5g/m2）,cytarabine（0.5~1.0g/m2）and dexamethasone（10mg/d）,patients in targeted therapy group（n=30）received rituximab（375mg/m2）and high-dose methotrexate（3.5g/m2）and patients in conventional therapy group（n=30）received high-dose methotrexate（3.5g/m2）and whole brain radiotherapy.The clinical therapeutic effect,adverse effect and 1-,3-year survival rate were compared among three groups.[Results]The complete remission rates of R-MAD group,targeted therapy group and conventional therapy group were 54.84%,33.33%and 16.67%（χ2=10.856,P=0.004）,and the total effective rates were 83.87%,66.67%and 53.33%（χ2=6.592,P=0.037）.The incidence of blood system toxicity,liver toxicity,gastrointestinal reaction and neurotoxicity of R-MAD group was significantly lower than that of conventional treatment group（P〈0.05）.The incidence of myelosuppression in R-MAD group was significantly higher than that in targeted group and conventional treatment group（P〈0.05）.The 1-and 3-year survival rates in R-MAD group were higher than those in other two groups（χ2=7.715,8.139,P=0.021,0.017）.[Conclusion]Rituximab combined with chemotherapy regimen can significantly increase therapeutic effect for elderly patients with primary central nervous system neoplasms and prolong survival time without increase in adverse reactions.
作者
宋春鸽
房佰俊
蔡晓萌
SONG Chun-ge;FANG Bai-jun;CAI Xiao-meng(The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Chin)
出处
《肿瘤学杂志》
CAS
2018年第5期487-491,共5页
Journal of Chinese Oncology
基金
国家自然科学基金资助项目(81370661)
