抗CD20单抗联合以吉西他滨为基础的化疗方案对儿童复发性弥漫大B细胞淋巴瘤的疗效分析

Efficacy of anti-CD20 monoclonal antibody in combination with Gemcitabine-based chemotherapy regimen in children with recurrent diffuse large B-cell lymphoma

目的探讨抗CD20单抗联合以吉西他滨为基础的化疗方案对儿童复发性弥漫大B细胞淋巴瘤(DLBCL)的疗效。方法回顾性分析2010年1月至2018年1月烟台市烟台山医院儿科及烟台市牟平区中医医院儿科收治的62例DLBCL患儿的临床资料,其中对照组32例采用以吉西他滨为基础的治疗方案(吉西他滨+顺铂+地塞米松),研究组30例在对照组基础上联合抗CD单抗治疗,治疗4个周期(21 d为1个周期)后评估2组临床疗效、治疗前后相关指标[叉头框蛋白P1(FOXP1)、B细胞淋巴瘤因子-6(Bcl-6)]阳性表达情况、不良反应发生情况及生存情况[3年无进展生存(PFS)、3年总生存(OS)]。符合正态分布的计量资料以±s表示,采用t检验;计数资料以率(%)表示,采用χ检验。等级资料比较采用秩和检验。结果随访至2021年3月,研究组总缓解率(RR)、疾病控制率(DCR)分别为93.33%(28/30例)、96.67%(29/30例),对照组RR、DCR分别为68.75%(22/32例)、81.25%(26/32例),研究组RR高于对照组(χ^(2)=5.995,P<0.05);两组DCR比较差异无统计学意义(χ^(2)=3.674,P>0.05)。治疗后研究组与对照组FOXP1阳性表达率均较治疗前降低[23.33%(7/30例)比76.67%(23/30例);50.00%(16/32例)比75.00%(24/32例),χ^(2)=17.067、4.267,均P<0.05],且研究组低于对照组(χ^(2)=4.179,P<0.05);治疗后研究组与对照组Bcl-6阳性表达率均较治疗前升高[86.67%(26/30例)比26.67%(8/30例);62.50%(20/32例)比31.25%(10/32例),χ^(2)=21.991、6.275,均P<0.05],且研究组高于对照组(χ^(2)=4.723,P<0.05)。研究组与对照组胃肠道反应、转氨酶升高、白细胞下降等不良反应等级比较差异均无统计学意义(Z=-1.074、-1.078、-0.834,均P>0.05)。两组3年PFS生存曲线与3年OS生存曲线均存在差异(χ^(2)=3.997、4.723,均P<0.05)。结论抗CD20单抗联合以吉西他滨为基础的化疗方案对儿童DLBCL具有良好的疗效,且不会明显增加患儿不良反应。

Objective To investigate the efficacy of anti-CD20 monoclonal antibody in combination with Gemcitabine-based chemotherapy regimen in children with recurrent diffuse large B-cell lymphoma(DLBCL).Methods The clinical data of 62 children with DLBCL admitted to the Department of Pediatrics,Yantai Mountain Hospital of Yantai City and the Department of Pediatrics,Muping District Traditional Chinese Medicine Hospital in Yantai City from January 2010 to January 2018 were analyzed retrospectively.Different treatment options were selected according to the children′s stage and the presence of risk factors such as huge tumors.Among them,32 cases in the control group were treated with the Gemcitabine-based treatment plan(Gemcitabine+Cisplatin+Dexamethasone treatment).Thirty patients in the study group were treated with anti-CD20 monoclonal antibody on the basis of the control group for a total of 4 cycles(21 d per cycle).After 4 cycles of treatment,the clinical efficacy,the positive expression of forkhead box protein P1(FOXP1)and B-cell lymphoma factor-6(Bcl-6)before and after treatment,the occurrence of adverse reactions and survival[3-year progression-free survival(PFS),3-year overall survival(OS)]were evaluated.The measurement data that meets the normal distribution is expressed that the t test is used,and the counting data is represented by(%),and theχ^(2) test is used.Level data is compared with ranking and inspection.Results All patients were followed up to March 2021.The total response rate(RR)and disease control rate(DCR)of the study group were 93.33%(28/30 cases)and 96.67%(29/30 cases),respectively.The RR and DCR of the control group were 68.75%(22/32 cases)and 81.25%(26/32 cases),respectively.The RR of the study group was higher than that of the control group(χ^(2)=5.995,P<0.05),and there was no statistical difference in DCR between the two groups(χ^(2)=3.674,P>0.05).After treatment,the positive expression rate of FOXP1 in the study group and the control group was lower than before treatment[23.33%(7/30 cases)vs.76.67%(23/30 cases);50.00%(16/32 cases)vs.75.00%(24/32 cases),χ^(2)=17.067,4.267,all P<0.05],and the positive expression rate of the study group was lower than that of the control group(χ^(2)=4.179,P<0.05).After treatment,the positive expression rate of Bcl-6 in the study group and the control group was higher than before treatment[86.67%(26/30 cases)vs.26.67%(8/30 cases);62.50%(20/32 cases)vs.31.25%(10/32 cases),χ^(2)=21.991,6.275,all P<0.05],and the positive expression rate of the study group was higher than that of the control group(χ^(2)=4.723,P<0.05).There was no significant difference between the study group and the control group in the level of gastrointestinal reactions,elevated transa-minase,and decreased white blood cell(Z=-1.074,-1.078,-0.834,all P>0.05).There was a difference between the 3-year PFS survival curve and the 3-year OS survival curve between the two groups(χ^(2)=3.997,4.723,all P<0.05).Conclusions Anti-CD20 monoclonal antibody combined with Gemcitabine-based chemotherapy is effective for children with DLBCL,and will not significantly increase the adverse reactions in children.