老年初诊弥漫性大B细胞淋巴瘤患者临床特点回顾性分析

A retrospective analysis of the clinical characteristics in newly diagnosed diffuse large B-cell lymphoma in elderly patients aged 70 years and over

目的探讨老年弥漫性大B细胞淋巴瘤（DLBCL）患者的预后危险因素及可行的治疗方案。方法收集我院近10年收治≥70岁老年初诊DLBCL患者的临床资料及生存资料，回顾性分析影响患者治疗有效率、总生存期（0s）和无进展生存期（PFS）的因素。结果本组患者49例，年龄70～92岁，中位年龄76岁；其中≥80岁18例，〈80岁31例。治疗以美罗华（R）联合环磷酰胺（C）、阿霉素（H）、长春新碱（0）、强的松（P）方案（R—CHOP）为基础，体能状态较差或≥80岁患者，美罗华剂量不变，CHOP以标准剂量的50％～75％为初始剂量。49例患者中，完全缓解23例（46．9％），部分缓解9例（18．4％），总有效率65．3％。至随访截止日期共死亡30例，中位总生存期25个月。AnnArbor分期Ⅰ～Ⅱ期、LDH（乳酸脱氢酶）〈245U／L、年龄〈80岁、IPI（国际预后指数）≤2、6疗程R—CHOP与总生存期延长有关；多因素分析结果显示，LDH％245U／L和6疗程R-CHOP为独立预后因素。完成6程R—CHOP方案治疗，≥80岁组7例（38．9％），〈80岁组17例（54．8％）；两组患者总生存期（32个月比34个月）和无进展生存期（32个月比32个月）比较，差异无统计学意义。结论对于不能耐受标准剂量治疗的高龄患者，通过减低剂量并完成6程RCHOP治疗，能够改善患者预后；6程R—CHOP是影响老年DLBCL患者预后的独立危险因素。

Objective To explore the prognostic factors and treatment regimens of diffuse large B-cell lymphoma （DLBCL） in elderly patients. Methods The data of characteristics, treatment regimens and outcomes were collected in elderly patients aged 70 years and over, with newly diagnosed DLBCL from our hospital in the last decade. Then the factors influencing therapeutic response, overall survival and progression-free survival were analyzed. Results A total of 49 patients aged 70 to 92 years （median 76 years） were enrolled in this study. Among them, 18 patients were aged ≥80 years and older; the other 31 patients were aged less than 80 years. The treatment regimen was based on Rituximab （ R）, Cyclophosphamide （ C）, Adriamycin （ H ）, Vincristine （ O）, Prednisone （P） （R-CHOP）. For the patients with worse performance status, or80 years, 50%-75% of standard dose of CHOP plus 100% of Rituximab （R） dose were as starting dose. The complete remission rate was 46.9% and partial remission rate was 18.4%, the overall effective rate was 65.3% The 30 cases were in deaths. The median overall survival period was 25 months. The overall survival prolongation was associated with Ann Arbor staging Ⅰ-Ⅱ , serum lactate dehydrogenase less than 245 U/L, age less than 80 years, IPI≤2 and completing 6 cycles of R-CHOP. And multivariate regression analysis showed that serum lactate dehydrogenase less than 245 U/L and 6 cycles of R-CHOP were the independent prognostic factors. Among patients who completed 6 cycles of R-CHOP treatment regimen, there were 7 patients aged over 80 years （38.9%） and 17 patients aged less than 80 years （54.8%）. There were no significant differences between different age groups in overall survival （32 months vs. 34 months） and in progression-free survival （32 months vs. 32 months）. Conclusions Reduced treatment intensity so as to complete the 6 cycles of R-CHOP treatment regimen couldimprove the outcomes of older patients who could not tolerance the dose of standard treatment regimen. And 6 cycles of R-CHOP treatment regimen are the independent prognostic factor for survival.