老年人难治弥漫大B细胞淋巴瘤不同挽救方案疗效分析

The efficacy of different regimens in the salvage therapy of elderly patients with refractory diffuse large Bcell lymphoma

目的探讨美罗华联合吉西他滨和奥沙利铂方案（R—GemOx）和吉西他滨联合奥沙利铂（GemOx）方案挽救治疗老年人复发难治弥漫大B细胞淋巴瘤的疗效和不良反应。方法老年复发难治弥漫大B细胞淋巴瘤患者39例，分别接受RGemOx或GemOx方案化疗，其中R—GemOx组16例、GemOx组23例；吉西他滨1000mg／m2，静脉滴注，第1天、第8天；奥沙利铂（LOHP）130mg／m2，静脉滴注，第1天；部分患者经济允许并知情同意情况下，联合使用美罗华375mg／m2，静脉滴注，用吉西他滨前一天给药。21～28d为1个周期，完成1个周期化疗后评价不良反应，完成2个周期化疗后评价疗效。结果RGemOx组总有效率（完全缓解率＋部分缓解率）为62．5％，临床获益率[完全缓解率＋部分缓解率＋病情稳定率]为87．5％；GemOx组分别为47．8％和73．9％，差异无统计学意义（P=0．366）。RGemOx组中位疾病进展时间（TTP）为6．4个月，GemOx组中位TTP5．0个月，差异有统计学意义（P〈0．05）。两组主要不良反应为骨髓抑制、胃肠道反应，两组问差异无统计学意义。结论R—GemOx和GemOx方案挽救治疗老年人复发难治性弥漫大B细胞淋巴瘤安全有效，R-GemOx方案有效率高于GemOx方案，且能达到更长的疾病进展时间。

Objective To evaluate the efficacy and toxicities of gemcitabine plus oxaliplatin with R GemOx or without （GemOx） rituximab regimen in the treatment of relapsed or refractory diffuse large B-cell lymphoma in elderly patients~ Methods A total of 39 patients with relapsed or refractory diffuse large B cell lymphoma received R-GemOx or GemOx chemotherapy. There were 16 patients in R GemOx and 23 patients in GemOx group. Patients in both groups received gemcitabine 1000 mg/m2 , dl, at land 8 day and oxaliplatin 130 mg/m2, dl at lday. Patients in R GemOx additionally received rituximab 375 mg/me. Every 21-28 days was 1 cycle. The toxicities were evaluated after 1 cycle of chemotherapy. The efficacy was evaluated after 2 cycles of chemotherapy. Results In R-GemOx group, the total response rate was 62.5~, and the clinical benefit rate was 87.5~. In GemOx group, the total response rate was 47.8~, and the clinical benefit rate was 73.9X ~ There was no significant differences between the two groups. There was a significant difference in the median time-to-progression （TTP） between R-GemOx group （6.4 months） and GemOx group （5.0 months） （P ~ 0.05）. The major toxicities were marrow suppression and gastrointestinal reaction, which had no significant differences between the two groups. Conclusions R GemOx and GemOx regimen are effective and safe for the elderly patients with relapsed or refractory diffuse large B-cell lymphoma（DLBCL）. But the patients with relapsed/refractory DLBCL treated with R-GemOx had a longer median time-to progression than with GemOx regimen.