R-DICE及R-EPOCH方案对复发难治性弥漫大B细胞淋巴瘤疗效比较

Comparison of R-DICE and R-EPOCH regimens in the treatment of relapsed and refractory diffuse large B-cell lymphoma

目的:比较R-DICE方案与R-EPOCH方案对复发、难治性弥漫大B细胞淋巴瘤(DLBCL)患者的疗效及毒副作用。方法:回顾性分析72例复发、难治性DLBCL患者临床资料,根据挽救性治疗方案不同分为R-DICE组38例及R-EPOCH组34例,观察两组治疗有效率、缓解持续时间及毒副反应。结果:R-DICE组完全缓解率73.7%,部分缓解率13.2%,有效率为86.8%,平均缓解持续时间213.17±16.55天。R-EPOCH组完全缓解率73.5%,部分缓解率17.6%,有效率为91.2%,平均缓解持续时间125.29±13.12天。R-EPOCH组有效率高于R-DICE组,而缓解持续时间短于R-DICE组,但差异均无统计学意义(P>0.05)。R-DICE组中29例Ki-67增殖指数>60%,平均缓解持续时间228.11±15.28天;R-EPOCH组中25例Ki-67增殖指数>60%,平均缓解持续时间117.43±11.75天,短于R-DICE组,但差异无统计学意义(P>0.05)。R-DICE组共化疗89例次,R-EPOCH组共化疗71例次。R-DICE组中白细胞减少23例次(25.8%),贫血19例次(21.3%),血小板减少11例次(12.4%),恶心呕吐19例次(21.3%),口腔粘膜损伤17例次(19.1%)。R-EPOCH组白细胞减少34例次(47.9%),贫血21例次(29.6%),血小板减少13例次(18.3%),恶心呕吐3例次(4.2%),无口腔粘膜损伤。R-EPOCH组白细胞减少、贫血及血小板减少发生率高于R-DICE组,而恶心呕吐及口腔粘膜损伤发生率低于R-DICE组,差异均有统计学意义(P<0.05)。结论:R-DICE及R-EPOCH方案均可作为复发、难治性DLBCL的挽救性治疗,R-EPOCH方案的患者平均缓解持续时间短于R-DICE,R-DICE血液学毒性较轻,而R-EPOCH胃肠道反应及口腔粘膜损伤较轻。对白细胞数较低患者可优先选择R-DICE方案,而对依从性较好的老年患者则可选择R-EPOCH方案。

Objective:To compare the efficacy and toxicity of R-DICE regimen and R-EPOCH regimen in the treatment of relapsed and refractory diffuse large B-cell lymphoma(DLBCL).Methods:The clinical data of 72 patients with relapsed and refractory DLBCL were retrospectively analyzed.According to the different salvage treatment schemes,they were divided into R-DICE group(n=38)and R-EPOCH group(n=34).Results:In the R-DICE group,the complete response rate was 73.7%,the partial response rate was 13.2%,and the effective rate was 86.8%.The average duration of remission was 213.17±16.55 days.In the R-EPOCH group,the complete response rate was 73.5%,the partial response rate was 17.6%,and the effective rate was 91.2%.The average duration of remission was 125.29±13.12 days.The effective rate of the R-EPOCH group was higher than that of the R-DICE group,and the duration of remission was shorter than that of the R-DICE group,but the difference was not statistically significant(P>0.05).In the R-DICE group,the proliferation index of Ki-67 in 29 cases was higher than 60%,and the average remission duration was 228.11±15.28 days;in the R-EPOCH group,Ki-67 proliferation index was more than 60%,and the average remission duration was 117.43±11.75 days,which was shorter than that in the R-DICE group,but the difference was not statistically significant(P>0.05).There were 89 cases of chemotherapy in the R-DICE group and 71 cases in the R-EPOCH group.In the R-DICE group,there were 23 cases of leukopenia(25.8%),19 cases of anemia(21.3%),11 cases of thrombocytopenia(12.4%),19 cases of nausea and vomiting(21.3%),17 cases of oral mucosal injury(19.1%).In the R-EPOCH group,leukopenia occurred in 34 cases(47.9%),anemia in 21 cases(29.6%),thrombocytopenia in 13 cases(18.3%),nausea and vomiting in 3 cases(4.2%),and no oral mucosal injury was found.The incidence of leukopenia,anemia and thrombocytopenia in the R-EPOCH group was higher than that in the R-DICE group,while the incidence of nausea and vomiting and oral mucosal injury was lower than that in the R-DICE group(P<0.05).Conclusion:Both R-DICE and R-EPOCH can be used as salvage treatment for relapsed and refractory DLBCL.The average remission duration of R-EPOCH is shorter than that of R-DICE,and the hematological toxicity of R-DICE is less,while the gastrointestinal reaction and oral mucosal injury of R-EPOCH are lighter.R-DICE regimen is preferred for patients with low WBC count,and R-EPOCH regimen is preferred for elderly patients with good compliance.