摘要
目的:分析利妥昔单抗联合CHOP/EPOCH方案治疗弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)患者的疗效,并探讨难治复发患者的高危因素。方法:对2012年12月-2018年12月东南大学附属中大医院血液科收治的72例初治DLBCL患者的临床资料进行回顾性分析,分析DLBCL患者应用利妥昔单抗联合CHOP/EPOCH方案化疗的缓解率。同时进行生存分析,探讨影响难治复发的高危因素。结果:72例患者中,45例获得CR,11例获得PR,总缓解率77.78%,其中难治复发患者25例,复发率34.2%。单因素分析显示,B症状、低Hb水平、高NLR、低LMR、高β2-MG、高ESR、高hs-CRP、高LDH、低ALB、低HDL与难治复发DLBCL明显相关。多因素Logistic分析显示,B症状、Hb、β2-MG、ESR、hs-CRP与DLBCL难治复发具有明显相关性。生存分析表明,难治复发组的OS明显低于反应组。另外,B症状、贫血、低LMR、高β2-MG、高hs-CRP、高LDH、低ALB及低HDL患者的OS明显低于对照组。结论:利妥昔单抗联合CHOP/EPOCH方案治疗DLBCL的缓解率较高,但仍有约1/3的患者难治复发。B症状、低Hb、高β2-MG、高ESR、高hs-CRP是导致DLBCL难治复发的独立预后因素。
Objective:To analyze the efficacy of rituximab combined with CHOP/EPOCH regimen for treatment of diffuse large B-cell lymphoma(DLBCL)patients,and to explore the high risk factors of refractory and relapsed patients.Methods:The clinical data of 72 patients with de novo DLBCL from December 2012 to December 2018 in the Department of Hematology,Zhongda Hospital Affiliated to Southeast University were retrospectively analyzed.The remission rate of DLBCL patients treated by rituximab combined with CHOP/EPOCH was analyzed,and survival analysis was conducted to explore the risk factors influencing refractory recurrence.Results:45 cases among 72 patients achieved complete remission(CR),11 cases achieved partial remission(PR),the total remission rate was 77.78%.25 cases(34.2%)refractory and relapsed.Single factor analysis showed that the B symptoms,low Hb,high NLR,low MLR,highβ2-MG,high ESR,high hs-CRP,high LDH,low ALB,low HDL were high risk factors of refractory and relapsed DLBCL.Multivariate Logistic analysis showed B symptoms,low Hb,highβ2-MG,high ESR,and high hs-CRP were significantly related with refractory relapse.Survival analysis showed that OS of refractory and relapsed group was significantly worse than that in remission group.In addition,OS of patients with B symptoms,anemia,low LMR,highβ2-MG,high hs-CRP,high LDH,low ALB and low HDL was significantly worse than that of control group.Conclusion:The remission rate of DLBCL patients treated by rituximab combined with CHOP/EPOCH regimen is high,but about one third of the patients still show refractory and relapsed.B Symptoms,anemia,highβ2-MG,ESR and hs-CRP are the independent prognostic factors.
作者
张静
顾岩
吴雪
高冲
陈宝安
ZHANG Jing;GU Yan;WU Xue;GAO Chong;CHEN Bao-An(Department of Hematology,Zhongda Hospital,School of Medicine,Southeast University,Nanjing 210009,Jiangsu Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2020年第6期1912-1918,共7页
Journal of Experimental Hematology
基金
江苏省医学重点学科(ZDXKB201620)
江苏省社会发展项目(BE2018711)
江苏省研究生科研与实践创新计划项目(SJCX18_0068)
国家自然科学基金青年科学基金(81800197)。
关键词
弥漫大B细胞淋巴瘤
难治复发
预后因素
diffuse large B-cell lymphoma
refractory relapse
prognostic factors
