R-CDOP方案治疗大包块和(或)结外多部位累及的弥漫大B细胞淋巴瘤患者2年疗效和安全性观察

The efficacy and safety of R-CDOP regimen in the treatment of large mass and/or multi-site extranodal of diffuse large B-cell lymphoma in 2 years

目的:观察R-CDOP(利妥昔单抗、环磷酰胺、脂质体多柔比星、长春地辛、泼尼松)方案治疗大包块和(或)结外多部位累及的弥漫大B细胞淋巴瘤(DLBCL)患者的2年疗效和安全性。方法:选择2015-01-2017-06在我院血液科初诊的大包块和(或)结外多部位累及的DLBCL患者78例,其中接受R-CDOP方案治疗的患者33例,接受R-CHOP(利妥昔单抗、环磷酰胺、表柔比星、长春地辛、泼尼松)方案治疗的患者45例。回顾性分析所有患者的临床资料,比较2组患者化疗4个疗程及6~8个疗程结束后的客观反应率(ORR)。随访2年,比较2组患者2年的总生存率(OS)和2年无病进展生存率(PFS);观察2组化疗期间及随访2年内不良事件的发生情况,包括骨髓抑制、肝肾毒性、胃肠道反应、心脏毒性和间质性肺炎等。结果:①化疗4个疗程后评估疗效,R-CDOP组的ORR明显优于R-CHOP组,差异有统计学意义(87.9%∶68.9%,P<0.05);6~8个疗程结束后R-CDOP组的ORR也明显优于R-CHOP组,差异有统计学意义(84.8%∶64.4%,P<0.05)。②R-CDOP组的2年OS率及PFS率优于R-CHOP组,但差异无统计学意义(54.5%∶45.8%,45.5%∶40.0%,P>0.05)。③R-CDOP组和R-CHOP组的骨髓抑制、肝肾毒性、胃肠道反应相近,差异无统计学意义(P>0.05);R-CDOP组的间质性肺炎发生率明显高于R-CHOP组,而心脏毒性发生率明显低于R-CHOP组,差异均有统计学意义(P<0.05)。结论:R-CDOP方案治疗大包块和(或)结外多部位累及DLBCL的早期疗效明显优于R-CHOP方案,远期疗效的优势尚需进一步观察证实。除间质性肺炎的发生率升高之外,R-CDOP方案的其他常见不良反应与R-CHOP方案相似,但心脏毒性明显减少。

Objective:To observe the efficacy and safety of R-CDOP(rituximab,cyclophosphamide,liposome doxorubicin,vindesine,prednisone)in the treatment of diffuse large B-cell lymphoma(DLBCL)patients with large mass and/or multi-site extranodal involvement.Method:A total of 78 DLBCL patients with massive and/or multisite extranodal involvement were selected from January 2015 to June 2017.Among them,33 patients treated with R-CDOP regimen,45 patients treated with R-CHOP(rituximab,cyclophosphamide,epirubicin,vindesine,prednisone).The clinical data of all patients were analyzed retrospectively.And the objective response rate(ORR)after4 courses and 6 to 8 courses of chemotherapy were compared between two groups.These patients were followed up for 2 years,and the 2-year overall survival rate(OS)and 2-year disease-free survival rate(PFS)were also compared between two groups.The adverse events during chemotherapy and 2 years of follow-up were also observed,including myelosuppression,hepatorenal toxicity,gastrointestinal reaction,cardiotoxicity and interstitial pneumonia.Result:(1)After 4 courses of chemotherapy,the ORR of R-CDOP group was significantly better than that of R-CHOP group(87.9% vs 68.9%,P<0.05).After 6 to 8 courses of chemotherapy,the ORR of R-CDOP group was also significantly better than that of R-CHOP group(84.8% vs 64.4%,P<0.05).(2)The 2-year OS rate and PFS rate of R-CDOP group were better than those of R-CHOP group,but there was no significant difference (54.5%vs 45.8%,45.5%vs 40.0%,P>0.05).(3)There was no significant difference in myelosuppression,hepatorenal toxicity and gastrointestinal reaction between R-CDOP group and R-CHOP group(P>0.05).The incidence of interstitial pneumonia in R-CDOP group was significantly higher than that in R-CHOP group,while the incidence of cardiotoxicity was significantly lower than that in R-CHOP group(P<0.05).Conclusion:The early curative efficacy of R-CDOP regimen in the treatment of large mass and/or multi-site extranodal involvement of DLBCL is significantly better than that of R-CHOP regimen,and the long-term effect needs to be further observed.Except for the increased incidence of interstitial pneumonia,the other common adverse events of R-CDOP regimen are similar to those of R-CHOP regimen,but the cardiotoxicity is significantly reduced.