R-CHOP方案治疗年轻弥漫性大B细胞淋巴瘤患者预后分析

Prognosis of R-CHOP regimen in treatment of young adult patients with diffuse large B-cell lymphoma

目的评估利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和强的松（R—CHOP）治疗年轻患者的弥漫性大B细胞淋巴瘤（DLBCL）的预后。方法选择2000年2月-2006年9月在该中心接受治疗的96例年轻的初治DLBCL患者接受6个疗程的R-CHOP治疗。结果96例患者中66例（68．8％）获得完全反应（CR），12例（12．5％）获得部分反应（PR），总反应率为81．3％；疾病稳定（SD）和疾病进展（PD）各9例（9．4％）。在多因素分析中，临床分期和大包块病变在获得CR方面均有显著性差异（均P〈0．05）。患者24个月的无进展生存时间（PFS）和OS率分别为（59．9±5．8）％和（67．4±6．1）％。在多因素分析中，有无大包块和是否获得CR是影响PFS的两个预后因素（均P〈0．05），而唯一影响OS的指标则为是否获得CR（P〈0．05）。结论6个疗程治疗后获得CR和大包块病变是两个非常重要的独立于国际预后指数的因素。

Objective To assess the prognosis of rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisone （R-CHOP regimen） in the treatment of young adult patients with diffuse large B-cell lymphoma （DLBCL）. Methods Ninety-six patients received treatment in our center with newly diagnosed DLBCL from February 2000 to September 2006 were evaluated, and all were administered six courses of R-CHOP therapy. Results The complete response （CR） was observed in 66 （68.8%） out of 96 patients, the partial remission （PR） in 12 （12.5%）, and the overall response rate was 81.3%. Nine patients （9.4%） remained stable and 9 （9.4%） experienced progression. Multivariate analysis of potential prognostic factors predictive for achieving CR only included clinical stage and bulky disease （ P 〈 0.05）. The 24-month progression-free survival （PFS） and overall survival （OS） were （ 59.9 ± 5.8 ） % and （67.4 ± 6.1 ） % , respectively. Multivariate analysis demonstrated that CR was the only independent prognostic factors of OS （ P 〈 0.05）, while bulky disease and CR were prognostic factors of PFS （ P 〈 0.05 ）. Conclusion Achieving CR after six courses of treatment and bulky disease are two significant prognostic factors independent of international prognostic index.