利妥昔单抗联合标准CHOP方案或分割剂量的CHOP方案治疗原发于胃的弥漫大B细胞淋巴瘤的疗效和安全性

Efficacy and safety of rituximab combined with CHOP or combined with dose fractionated CHOP in the treatment of primary gastric diffuse large B cell lymphoma

目的比较利妥昔单抗联合CHOP方案（R—CHOP）和利妥昔单抗联合分割剂量的CHOP方案（R-fCHOP）治疗原发于胃的弥漫大B细胞淋巴瘤（PG—DLBCL）的疗效和安全性。方法回顾性收集2010年3月至2014年3月在复旦大学附属肿瘤医院治疗的50例PG—DLBCL患者的临床资料，比较接受R-CHOP和R—fCHOP方案的两组患者在治疗过程中消化道出血、穿孔的发生率及其对后续治疗的影响，同时比较两组患者的疗效。结果40例患者接受了R-CHOP方案化疗，10例患者接受了R—fCHOP方案化疗。接受R-fCHOP方案化疗的患者Lugano分期较晚，胃溃疡的大小和深度均较大。接受R—fCHOP方案化疗的患者中，有1例（10．0％）出现大便隐血阳性；接受R—CHOP方案化疗的患者中，有11例（31．4％）出现大便隐血阳性，其中1例患者因呕血停止了后续化疗。两组患者化疗后均未出现穿孔。接受R—CHOP方案和R—fCHOP方案化疗患者的有效率分别为92．5％和90．0％，差异无统计学意义（P〉0．05）。两组患者的无进展生存曲线的差异无统计学意义（P〉0．05）。结论R-fCHOP方案在Lugano分期晚，溃疡较深、较大的高出血穿孔风险PG—DLBCL患者中有较好的安全性，其近期疗效与R-CHOP方案相似。

Objective The aim of this study was to compare the safety and efficacy profiles of R- CHOP and R-fCHOP regimes in the treatment of primary gastric diffuse large B cell lymphoma （PG- DLBCL）. Methods Data of PG-DLBCL patients admitted in our hospital from March 2010 to March 2014 were collected retrospectively. Differences in gastrointestinal bleeding and perforation between the R-CHOP group and R-fCHOP group were compared. The influence of the gastrointestinal complication on subsequent treatment was also analyzed. Treatment outcome of the two groups was also compared. Results A total of 50 patients were included in this retrospective study. Forty of them were in the R-CHOP group, another ten were in the R-fCHOP group. Patients in the R-fCHOP group had a higher rate of Lugano late stage disease, and a relatively high rate of a deeper/larger ulcer. Fence occult blood test （FOBT） was positive in one （ 10.0% ） patient in the R-fCHOP group, and 11 （31.4%） patients in the R-CHOP group, among them one had hematemesis and had to give up the subsequent chemotherapy. No perforation was observed in both groups. The response rate （RR） was 92.5% in the R-CHOP group and 90.0% in the R-fCHOP group （P 〉 0.05 ）. The PFS was also comparable between the two groups （P 〉 0.05 ）. Conclusions R-fCHOP regimen has a good safety profile in patients with Lugano late stage and deep/large ulcers, who are of high risk of gastrointestinal bleeding or perforation, and also has a comparable efficacy profile when compared with the R- CHOP regimen in short-term follow-up.