伊布替尼联合利妥昔单抗挽救性治疗老年难治弥漫大B细胞淋巴瘤致间质性肺炎的临床分析

Clinical analysis of interstitial pneumonia after salvage treatment of ibrutinib combined with rituximab in elderly patients with refractory diffuse large B-cell lymphoma

目的探讨伊布替尼联合利妥昔单抗挽救性治疗老年难治弥漫大B细胞淋巴瘤(DLBCL)致间质性肺炎(IP)的发生情况,并明确其影响因素。方法收集2016年3月至2021年3月221例老年难治DLBCL患者,均接受伊布替尼联合利妥昔单抗+环磷酰胺+阿霉素+长春新碱+泼尼松(R-CHOP)方案治疗,统计IP的发生率及影响因素,并通过Logistic回归模型、受试者工作特征曲线(ROC)及曲线下面积(AUC)分析上述危险因素对IP发生的预测价值。结果221例老年DLBCL患者经伊布替尼联合利妥昔单抗挽救性治疗后IP的发生率为11.8%(26/221)。Logistic回归分析显示,年龄、肺实质侵犯、Ann Arbor分期、乳酸脱氢酶(LDH)水平、IPI评分、肺部感染史和吸烟史是影响IP发生的独立因素(P<0.05)。Logistic回归模型统计分析数据集,根据预测值和真实值绘制ROC曲线,AUC为0.924(95%CI:0.869~0.979),预测灵敏度为92.31%,特异度为84.62%。结论伊布替尼联合利妥昔单抗挽救性治疗老年难治DLBCL患者的IP发生率为11.8%,主要与吸烟史、肺部感染史、肺实质侵犯和LDH水平等因素有关,建议做好上述危险因素干预,降低IP发生率。

Objective To investigate the occurrence of interstitial pneumonia(IP)after rescue treatment of ibrutinib combined with rituximab in refractory diffuse large B-cell lymphoma(DLBCL)in the elderly,and to clarify its influencing factors.Methods A total of 221 elderly refractory DLBCL patients from March 2016 to March 2021 were enrolled,and they were treated with ibrutinib combined with R-CHOP(rituximab+cyclophosphamide+adriamycin+vincristine+prednisone)regimen.The incidence and influencing factors of IP were counted,and the predictive value of the above risk factors on the incidence of IP was analyzed by Logistic regression model,receiver operating characteristic(ROC)curve and area under the curve(AUC).Results The incidence of IP in 221 elderly patients with DLBCL was 11.8%after salvage treatment with ibrutinib combined with rituximab.Logistic regression equation showed that age,lung parenchyma invasion,Ann Arbor stage,lactate dehydrogenase(LDH)level,IPI score,history of lung infection and smoking were independent factors affecting the occurrence of IP(P<0.05).The data set was statistically analyzed by Logistic regression model,and ROC curve was made according to the predicted value and the real value.The AUC was 0.924(95%CI:0.869-0.979),the predictive sensitivity was 92.31%,and the specificity was 84.62%.Conclusion The incidence of IP in elderly patients with refractory DLBCL treated with ibrutinib combined with rituximab was 11.8%,which was mainly related to smoking history,lung infection history,lung parenchyma invasion,LDH level and other factors.It is recommended to do a good job in the intervention of the above risk factors in order to reduce the incidence of IP.