摘要
目的比较RCHOP和RCDOP方案治疗弥漫大B细胞淋巴瘤(DLBCL)后间质性肺炎的发生情况。方法回顾性分析2013年1月至2018年8月上海交通大学医学院附属瑞金医院血液科收治的DLBCL患者836例,其中接受RCDOP方案者114例,根据年龄、性别、IPI评分等因素1∶1配对,选出114例接受RCHOP方案的患者作为对照组。收集患者的基础疾病状况、性别、年龄、有无B症状、IPI评分、疾病分期、血LDH、血β2-微球蛋白等相关临床资料,进一步分析间质性肺炎发生的危险因素。结果RCHOP方案和RCDOP方案治疗DLBCL后间质性肺炎的发生率分别为2.60%和28.95%,差异有统计学意义(P<0.01)。RCDOP方案中,随着脂质体阿霉素剂量自25~30 mg/m^2增加至35~40 mg/m^2,患者的完全缓解率自76.90%增至85.50%(P>0.05),间质性肺炎的发生率也自17.30%增至38.71%(P<0.05)。多因素回归分析显示,应用RCDOP方案、治疗前Ann Arbor分期高是患者预后不良的独立危险因素。结论应用RCDOP方案治疗DLBCL时需加强对间质性肺炎的预防和监测。
Objective To identify the risk factors and clinical features associated with the interstitial pneumonia in diffuse large B-cell lymphoma(DLBCL)patients treated with rituximab,cyclophosphamide,doxorubicin,vincristine and prednisone(RCHOP)or rituximab,cyclophosphamide,liposomal doxorubicin,vincristine and prednisone(RCDOP)regimens.Methods A retrospective study was conducted in 836 patients with DLBCL admitted to the Department of Hematology at Ruijin Hospital from 2013 to 2018.Among them,114 patients were treated with RCDOP regimen.Using the method of propensity score matching according to age,gender,IPI score of patients,114 patients treated with RCHOP regimen were selected as controls.Clinical data,including comorbidities,gender,age,B symptoms,international prognostic index(IPI)score,disease stage,serum lactic dehydrogenase(LDH)andβ2 microglobulin(β2-MG)level were collected and the risk factors of interstitial pneumonia were further analyzed.Results The interstitial pneumonia developed more frequently in RCDOP group than RCHOP group(28.95%vs 2.60%,P<0.01).As the dose of liposomal doxorubicin elevated from 25-30 mg/m^2 to 35-40 mg/m^2,the incidence of interstitial pneumonia accordingly increased from 17.30%to 38.71%(P<0.05).By multivariate analysis,disease stage was an independent factor of interstitial pneumonitis.Conclusions Front line regimens containing liposomal doxorubicin in DLBCL patients link to a higher incidence of dose-dependent interstitial pneumonia.Prevention and surveillance should be emphasized in future studies.
作者
蒙延娜
王硕
施晴
许彭鹏
程澍
王黎
赵维莅
Meng Yanna;Wang Shuo;Shi Qing;Xu Pengpeng;Cheng Shu;Wang Li;Zhao Weili(Xuzhou Center Hospital,Xuzhou 221009,China;State Key Laboratory of Medical Genomics/Shanghai Institute of Hematology,Department of Hematology,Rui Jin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2019年第12期1015-1020,共6页
Chinese Journal of Hematology
基金
国家自然科学基金(81520108003,81670716,81830007)
上海市科委课题(16JC1405800)
±海市杰出青年医学人才培养计划
上海市教委高原高峰计划(20152206,20152208)
上海市人才基金。
关键词
非霍奇金淋巴瘤
抗肿瘤联合化疗方案
间质性肺炎
Non-Hodgkin’s lymphoma
Antineoplastic combined chemotherapy protocols
Interstitial pneumonia
