美罗华联合CHOP方案与CHOP方案治疗侵袭性B细胞性淋巴瘤的临床对比研究

Comparison of Rituximab plus CHOP regimen and CHOP regimen alone for treatment of patients with aggressive B-cell lymphoma

[目的]比较美罗华联合CHOP方案和单用CHOP方案治疗侵袭性B细胞性淋巴瘤的疗效、生存和不良反应。[方法]采用同期非随机对照的方法，将40例侵袭性B细胞性淋巴瘤患者分为美罗华联合CHOP组（R—CHOP）和CHOP纽。R—CHOP纽19例，采用CHOP方案（环磷酰胺＋阿霉素十长春新碱＋强的松）加美罗华（375mg／m^2，于每周期化疗前1天静脉滴注1次）治疗；CHOP组21例，单用CHOP方案化疗。两组均每3周1个周期．6周期后比较两组的疗效及不良反应，并随访总生存及无病生存率。[结果]40例患者中，R—CHOP组19例患者共完成121周期化疗，平均5—8周期，中位周期数为6周期；CHOP组21例患者共完成135周期化疗，平均4～8周期，中位周期数为6周期。R—CHOP组完全缓解10例，部分缓解7例，总有效率为89．5％（17／19）；CHOP组完全缓解9例，部分缓解6例，总有效率为71．4％（15／21），两组疗效差异有显著性意义（P〈0．05）：R—CHOP组和CHOP组1年总生存率为89．5％和71．4％，1年无进展生存率分别为78．9％和52．4％，R—CHOP组明显优于CHOP组（P〈0．05）。两组患者的不良反应主要为轻中度骨髓抑制和胃肠道反应，不良反应发生率相近（P〉0．05），两组均可耐受。[结论]美罗华联合CHOP方案能够提高CHOP方案治疗侵袭性B细胞性淋巴瘤的疗效。而毒性反应未见明显增加，可作为该病的一线治疗方案。

[ Objective ] This work is to evaluate the efficacy, survival and toxicity of combination of chemotherapy consisting of Rituximab and CHOP in patients with aggressive B - cell non - Hodgkin＇s lyinphomas. [ Methods J Forty patients with histopathologically proven CD20 - positive aggressive B - cell non - Hodgkin＇s lymphomas were assigned into R - CHOP group （19 patients） and CHOP group （21 patients）. CHOP regimen consisted of Cyclophosphamide, Vincristine, Epirubicin and Prednisone. The cycle was repeated every 21 days. R - CHOP regimen was Rituximab 375mg/m^2 that was infused on tbe first day, and CHOP that followed on the second day. All of the patients received 6 chemotherapy cycles. The patients were followed up and the therapeutic effect was assessed. [ Results] There were 10 CR and 7 PR in CHOP group and the overall response rate was 89.5% （17/19）. There were 9 CR and 6 PR in R - CHOP group and the overall response rate was 71.4% （15/21）. The response rate was significantly higher in the R -CHOP group than in the CHOP group （ P 〈 0.05 ）. The one - year survival rates were 89.5% in R - CHOP group and 71.4% in CHOP group respectively. The one - year PFS rates were 78.9% and 52.4% respectively in the two groups, with a significant difference between them（P 〈 0.05 ）. The major side effects in the two groups were mild to moderate myelosuppression and gastrointestinal toxicity, without a significant difference between them（P 〉 0. 05 ）. [ Conclusions] Combined chemotherapy including Rituximab and CHOP （ R - CHOP） is recommended as the preferred treatment for aggressive B - cell non - Hodgkin＇s lymphoma because it is effect and well tolerated by the patients.