FC与FCR方案治疗慢性淋巴细胞白血病的临床回顾性分析

Retrospective clinical analysis of fludarabine and cyclophosphamide with or without rituximab for the treatment of patients with chronic lymphocytic leukemia

目的:比较FC(氟达拉滨和环磷酰胺)和FCR(氟达拉滨、环磷酰胺和利妥昔单抗)方案治疗慢性淋巴细胞白血病(CLL)的临床疗效和预后影响。方法:回顾性分析本院2002年12月至2012年1月应用FC或FCR方案治疗的58例CLL患者病例资料,比较两种方案的疗效和预后影响。结果:FC组31例,FCR组27例。FCR组完全缓解(CR)率和总反应率(ORR)均高于FC组(44.4%vs.19.4%,P=0.039;81.5%vs.51.6%,P=0.017)。疗程结束后,FCR组患者获得微小残留病(microscopice residual disease,MRD)阴性比例高于FC组(37.0%vs.12.9%,P=0.032)。FCR和FC组患者中高危遗传学亚组患者PFS较非高危遗传学亚组患者短(P值分别为0.011,0.027),OS时间无明显差别。结论:FCR方案是治疗CLL患者的更为有效的方案。

Objective：This study aimed to compare the clinical efficacy and prognosis between rituximab plus fludarabine and cyclophosphamide （FCR） and fludarabine and cyclophosphamide （FC） regimens for patients with chronic lymphocytic leukemia （CLL）. Methods：The clinical data of 58 patients with CLL treated with FCR or FC regimens from December 2002 to January 2012 were analyzed retrospectively. Therapy efficacy and prognosis were compared between the two groups. Results：Among the 58 pa-tients, 27 （44.4%） experienced complete remission （CR） in the FCR group and 31 patients （19.4%） experienced CR in the FC group （P=0.039）. The overall response rate （ORR） of the FCR group was higher than that of the FC group （81.5%and 51.6%, respectively, P=0.017）. Fourteen patients achieved MRD-negative rating after therapy. PFS and OS in MRD-negative patients were superior compared with the MRD-positive group （P=0.000, 0.003）. The proportion of MRD-negative patients in the FCR group was higher than that in the FC group （37.0%and 12.9%, respectively, P=0.032）. PFS in high-risk genetic patients was lower than that in low-risk genetic patients （P=0.011, 0.027）. The OS time between the two groups did not exhibit any difference. Conclusion：FCR produced a high CR and ORR in patients with CLL. Many patients in the FCR group were responsive to the treatment. Thus, FCR could be a more effective regimen than FC for patients with CLL.