吉西他滨联合洛铂和地塞米松治疗非生发中心型弥漫大B细胞淋巴瘤的近期疗效观察

Short-term efficacy of gemcitabine combined with lobaplatin and dexamethasone regimen on non-germinal center B-cell diffuse large B cell lymphoma

目的:探讨GDL(吉西他滨、地塞米松、洛铂)与R-GDL、R-CHOP和CHOP治疗非生发中心型弥漫大B细胞淋巴瘤的近期疗效以及最佳治疗方案。方法:对确诊的非生发中心型弥漫大B细胞淋巴瘤109例患者,24例应用R-GDL方案治疗,28例应用GDL方案,25例应用R-CHOP方案,32例应用CHOP方案。前瞻性的随机对照比较R-GDL、GDL、R-CHOP和CHOP方案治疗患者的近期疗效,并评估治疗安全性。结果:R-GDL组完全缓解(CR)15例,部分缓解(PR)6例,总有效率为87.5%(21/24);GDL组CR 8例,PR 7例,总有效率为53.6%(15/28),R-CHOP组总有效率为64.0%(16/25),CHOP组43.8%(14/32)。其中GDL组显著优于CHOP组,P=0.04;加用美罗华组较单纯化疗组差异有统计学意义,P值分别为0.006、0.045。GDL组1年的无进展生存率(57.1%)显著优于CHOP组(46.9%),P=0.04;含美罗华组显著优于单纯化疗组,P值分别为0.034、0.002。含洛铂的方案血小板下降明显,需预防性应用升血小板的药物,其肝肾心脏毒性较小,加或不加美罗华不良反应率无明显改变。结论:吉西他滨联合洛铂、地塞米松方案有效率比R-GDL、R-CHOP和CHOP方案治疗非生发中心型弥漫大B细胞淋巴瘤略高,但骨髓抑制较重,在化疗的基础上增加美罗华能进一步提高疗效。

OBJECTIVE： This study was to compare the short-term efficacy of （R）-GDL,GDL, R-CHOP and CHOP regimens on Non Germinal center B cell diffuse large B cell lymphoma（non-GCB DLBCL） patients. To explore the opal real regimen for initial treatment. METHODS： A total 109 patients of non-GCB DLBCL were enrolled. According to dif ferent treatment regimens, the patients divided in four groups, including 24 patients by R-GDL, 28 patients by GDL, 25 pa tients by R CHOP and 32 patients by CHOP. Efficacy assessment was conducted after two cycles therapy with followed up the side effects. RESULTS： The total response rate in R-GDL group was 87.5%（21/24）,among which complete responses（CR） was in 15 patients and partial responses （PR） in 6 patients： The total response rate in GDL group was 53.6%（15/28） among which CR was in 8 patients and PR was in 7 patients. The total response rate in R CHOP and CHOP groups were 64.0%（16/25）,43.8%（14/32）. The therapeutic efficacy was significantly better in GDL group than in CHOP group（P〈0.05） ,and combination group was better than GDL and CHOP group（P= 0. 005, P=0. 045）. The l-year progression-freely survival rates were significantly higher in GDL group than that in CHOP group（P=0.04） ,com hination group was higher than that inGDL and CHOP groups（P=0. 034,P=0. 002）. The major adverse events in GDL group were hematological toxicities and nausea/vomit and other adverse events were rare. The adverse events in comhina tion groups were similar to simple chemotherapy groups. CONCLUSIONS： GDL regimen increases the therapeutic efficacy on newly diagnosed patients with non-Germinal center B-cell diffuse large B cell lymphoma,but the thrombocytopenia was severer than CHOP groups. The use of rituximab can increase efficacy.