美罗华联合CHOP方案与依托泊苷联合CHOP方案治疗弥漫大B细胞淋巴瘤临床研究

Comparison of efficacy and safety between rituximab plus CHOP and etoposide plus CHOP regimen in the treatment of patients with diffuse large B-cell lymphoma

目的回顾性研究美罗华联合CHOP(R-CHOP)方案和依托泊苷联合CHOP(E-CHOP)方案治疗弥漫大B细胞淋巴瘤(DLBCL)的疗效、生存率和不良反应。方法采用同期(2008年1月至2013年3月)非随机对照方法,将中国医科大学附属盛京医院收治的72例DLBCL患者分为2组,R-CHOP组37例,E-CHOP组35例,比较两组患者的疗效、生存率、无进展生存率及不良反应。结果 R-CHOP组患者完全缓解(CR)22例,部分缓解(PR)11例,总有效率(ORR)为89.2%(33/37);E-CHOP组CR11例,PR13例,ORR为68.6%(24/35),2组疗效比较差异有统计学意义(P=0.031);R-CHOP组和E-CHOP组1年总生存率分别为97.3%和94.3%,差异无统计学意义(P=0.609),1年无进展生存率分别为94.6%和74.3%,差异具有统计学意义(P=0.017)。两组患者的不良反应主要为胃肠道反应、轻中度骨髓抑制和输液相关不良反应,不良反应发生率相近,分别为37.8%和37.1%,差异无统计学意义(P>0.05)。结论 R-CHOP方案能够提高治疗DLBCL患者的疗效,而不良反应未见明显增加,可作为该病治疗的一线方案。

Objective To retrospectively study the effect, survival rate and adverse reactions of rituximab plus CHOP（R-CHOP） and etoposide plus CHOP（E-CHOP） regimen in the treatment of patients with diffuse large B-cell lymphoma（DLBCL）. Methods A total of 72 patients with DLBCL were non-randomly divided into two groups： 37 patients were treated with R-CHOP, the others with E-CHOP. NHL International Efficacy Assessment and WHO Criteria were used to assess the therapeutic effects and the adverse reactions respectively. Results The overall response rate of g-CHOP group was 89.2%, including 22 complete remissions（Cg） and 11 partial remissions（PR）, and that of the E-CHOP group was 68.6% with 11 CR and 13 PR. The response rate was significantly higher in g-CHOP group than in E-CHOP group（P=0.031）. The one-year survival rate was 97.3% in R-CHOP group and 94.3% in E-CHOP group respectively. There was no significant difference on one-year survival rate between the two groups（P〈0.05）. The one- year progression-free survival（PFS） rates were 94.6% and 74.3%, respectively. There was significant difference on PFS rates between the two groups（P=0.017）. The major side effects in both regimens were gastrointestinal toxicity, mild to moderate myelosuppression, and adverse reactions related to transfusion, whose rate had no significant difference（P〈0.05）. Conclusion Compared with E-CHOP, R-CHOP regimen increases the therapeutic efficacy in patients with DLBCL, and has no significant increase in toxicity. R-CHOP regimen should be applied as the first line chemotherapy.