EPOCH±R序贯DICE±R方案治疗原发乳腺弥漫大B细胞淋巴瘤疗效观察

Clinical Efficacy of EPOCH ± R Followed by DICE ± R Regimen for Primary Breast Diffuse Large B-Cell Lymphoma

目的:探讨EPOCH±R序贯DICE±R方案治疗原发乳腺弥漫大B细胞淋巴瘤的疗效及安全性。方法:2000年1月至2016年4月我院收治原发乳腺弥漫大B细胞淋巴瘤43例,其中24例接受CHOP±R方案治疗,另19例接受EPOCH±R序贯DICE±R方案治疗,比较2组的临床疗效、预后及不良反应。结果:EPOCH±R序贯DICE±R序贯治疗组的缓解率高于CHOP±R方案组,分别为84.2%和70.8%,而且复发率低,两者分别为6.25%和35.3%,5年OS分别为73.3%和45.2%(P=0.043),PFS分别为75%和47.4%(P=0.035);EPOCH±R序贯DICE±R方案组血液学毒性高于CHOP±R方案组,其中白细胞Ⅳ度减少高达63.2%,而在CHOP±R为25%,但易于控制,无治疗相关死亡。多因素分析显示,年龄(P=0.008;95%CI 0.026-0.579)、乳酸脱氢酶(P=0.007;95%CI 0.017-0.531)和放疗(P=0.045;95%CI 1.028-14.719)是重要的预后因素。结论:EPOCH±R序贯DICE±R方案对乳腺弥漫大B细胞淋巴瘤是安全有效的,而年龄和乳酸脱氢酶水平为不良预后因素,局部放疗能改善患者的预后。

Objective： To explore the clinical efficacy and safety of EPOCH ＋ R followed by DICE ± R regimen for primary breast diffuse large B-cell lymphoma. Methods： Forty-three patients with primary breast diffuse large B-cell lymphoma were admitted in our hosptial from January 2000 to April 2016. Among them 24 patients were treated with CHOP ±R regimen, 19 patients were treated with EPOCH ±＋ R followed by DICE ±R regimen. The clinical efficacy, survival rate and adverse effects were observed and compared between them. Results ： The complete rate in EPOCH± R followed by DICE ±R regimen group was higher than that in the CHOP -＋ R group （ 84. 2% vs 70. 8% ）, and the relapsed rate was lower in EPOCH ± R followed by DICE ± R regimen group than that in the CHOP ± R group （6.25% vs 35.3% ）. Progression-free survival （PFS） and overall survival （OS） rates of 5 years after diagnosis in the EPOCH ± R followed by DICE ± R group were significantly higher as compared with that in CHOP ± R group （ PFS, 75% vs 47. 4%, P = 0. 035 ; OS, 73.3% vs 45.2%, P = 0. 043 ）. Treatment-related hematologic adverse events were more serious in the EPOCH ± R followed by DICE ± R group（63.2% vs 25% ）. However, these adverse events were controlled and no treatment-related deaths were observed. Multivariate analysis showed that age （P = 0. 008; 95% CI, 0.026 to 0. 579）, radiotherapy （P = 0. 045 ; 95 % CI, 1. 028 to 14.719） and LDH level （P = 0. 007 ; 95% CI, 0. 017 to 0. 531 ） were independent prognostic factors for 5 year overall survival. Conclusion ： EPOCH ± R followed by DICE ± R regimen is an effective and safe treatment regimen for PB-DLBCL. Prognostic factors for survival are age, LDH level and radiotherapy.