二线方案治疗98例复发难治弥漫大B细胞淋巴瘤的疗效及预后分析

Efficacy and prognostic analysis of 98 cases of relapsed/refractory diffuse large B-cell lymphoma treated with second-line regimens

目的研究二线方案治疗复发或难治性弥漫大B细胞淋巴瘤（DLBCL）的有效性及相关预后因素。方法回顾性2004年7月至2016年6月收治的98例复发难治性DLBCL患者的临床资料，评估化疗结束后缓解率，采用Kaplan-Meier方法计算总生存期（OS），并采用Cox回归法进行多因素分析，寻找影响患者OS的独立预后因素。结果98例患者中男60例，女38例，中位年龄55.5（15~77）岁。48例（49.0%）获得缓解，其中完全缓解32例（32.7%），部分缓解16例。难治DLBCL（早期进展或复发〈12个月）（χ2=5.878，P=0.015）、IPI中高危/高危（χ2=5.930，P=0.015）和NCCN-IPI中高危/高危（χ2=4.961，P=0.026）是影响化疗缓解率的不良因素，生发中心来源型（GCB）与非生发中心来源型（non-GCB）患者的化疗缓解率差异无统计学意义[χ2=0.660，P=0.417]。1年OS率为51.0%，2年OS率为31.5%，中位OS时间为13.17个月。多因素分析显示，NCCN-IPI中高危/高危[HR=2.176（95%CI 1.338~3.538），P=0.002]是影响患者生存的独立危险因素，化疗后缓解是提高患者OS率的独立预后因素[HR=0.273（95%CI 0.165~0.452），P〈0.001]。结论NCCN-IPI可作为复发难治性DLBCL患者的一个强有力的预后评价手段，化疗后缓解是患者获得较长OS的独立预后因素。

ObjectiveTo evaluate the efficacy and prognostic factors of second-line regimens for patients with relapsed/refractory diffuse large B-cell lymphoma （DLBCL）.MethodsA retrospective analysis was performed in 98 patients with relapsed/refractory DLBCL who were treated with salvage regimens in Rui Jin Hospital from July 2004 to June 2016. Overall response rate （ORR） was evaluated after all treatment finished. Overall survival （OS） was analyzed by Kaplan-Meier method and multivariate by Cox proportional hazards models.ResultsThere were 60 males and 38 females with a median age of 55.5 （15-77） years. 48 （49.0%） patients responded to chemotherapy, and 32 （32.7%） patients achieved complete remission （CR）. Factors affecting ORR were progression disease or refractory/relapse status less than 12 months after diagnosis （χ2=5.878, P=0.015） , IPI intermediate-high/high risk （χ2=5.930, P=0.015） and NCCN-IPI intermediate-high/high risk （χ2=4.961, P=0.026）. No significance difference was observed in ORR between germinal-center B-cell type （GCB） and non-GCB （χ2=0.660, P=0.417）. One-year and 2-year OS rates were 51.0% and 31.5%, with median OS at 13.17 months, respectively. Multivariate analysis indicated NCCN-IPI intermediate-high/high risk[HR=2.176 （95%CI 1.338-3.538） , P=0.002] and response to chemotherapy [HR=0.273 （95%CI 0.165-0.452） , P〈0.001] were independent prognostic factors for survival.ConclusionNCCN-IPI is a valid predictor of outcome for patients with relapse/refractory DLBCL. Response to chemotherapy is an independent prognostic factor for better survival.