R-CHOP治疗老年弥漫性大B细胞淋巴瘤患者疗效及其预后相关影响因素分析

Analysis of efficacy and prognostic factors of R-CHOP in treatment of elderly patients with diffuse large B-cell lymphoma

目的探讨利妥昔单抗+环磷酰胺+多柔比星+长春新碱+泼尼松(R-CHOP)治疗老年弥漫性大B细胞淋巴瘤(DLBCL)患者疗效及其预后的相关影响因素。方法回顾性选取2018年1月—2023年3月收治的107例老年DLBCL作为研究对象,统计分析R-CHOP近期疗效和预后情况,并采用多因素回归分析影响疗效及其预后的相关因素。结果107例老年DLBCL患者,经过3个疗程治疗后,ORR为77.57%(83/107),其中完全缓解44例(41.12%),部分缓解39例(36.45%)。截至随访时间2024年3月,有31例(28.97%)患者在随访期间发生疾病进展或治疗相关不良事件导致的死亡;采用多分类有序Logistic回归分析显示,年龄>70岁(OR=2.628,P=0.020)、Ann Arbor分期Ⅲ~Ⅳ期(OR=4.004,P=0.003)、骨髓侵犯(OR=3.749,P=0.002)、LDH升高(OR=3.616,P=0.002)、β2-MG升高(OR=3.137,P=0.010)均为影响老年DLBCL患者R-CHOP治疗后疗效的独立危险因素(P<0.05);采用二元Logistic分析发现,年龄>70岁(OR=5.427,P=0.006)、活化B细胞样亚型(OR=5.777,P=0.014)、Ann Arbor分期Ⅲ~Ⅳ期(OR=3.465,P=0.026)、骨髓侵犯(OR=3.792,P=0.023)、治疗后无反应(OR=5.688,P=0.012)均为影响老年DLBCL患者R-CHOP治疗后预后的独立危险因素(P<0.05)。结论年龄>70岁、活化B细胞样亚型、Ann Arbor分期Ⅲ~Ⅳ期、治疗后无反应可能为影响老年DLBCL患者R-CHOP治疗后预后的独立危险因素,临床上可基于这类因素进行风险分层,以改善患者的预后。

Objective To explore the therapeutic effects of rituximab+cyclophosphamide+doxorubicin+vincristine+prednisone(R-CHOP)in the treatment of elderly patients with diffuse large B-cell lymphoma(DLBCL)and the factors related to prognosis.Methods A total of 107 elderly DLBCL patients admitted from January 2018 to March 2023 were retrospectively enrolled as the research subjects.The short-term efficacy of R-CHOP and the prognosis of patients were statistically analyzed.Multivariate regression analysis was used to analyze the related factors affecting the curative effect and prognosis.Results In the 107 elderly patients with DLBCL,ORR was 77.57%(83/107)after three courses of treatment,including 44 ones with complete remission(41.12%)and 39 ones with partial remission(36.45%).As of March 2024,31 patients(28.97%)had died from disease progression or treatment-related adverse events during follow-up.Multiple classification ordered logistic regression analysis showed that age>70 years old(OR=2.628,P=0.020),Ann Arbor stage Ⅲ to Ⅳ(OR=4.004,P=0.003),bone marrow invasion(OR=3.749,P=0.002),and elevated LDH(OR=3.616,P=0.002),and elevatedβ2-MG(OR=3.137,P=0.010)were independent risk factors for the efficacy of R-CHOP treatment in elderly DLBCL patients(P<0.05).Binary logistic analysis showed that age>70 years old(OR=5.427,P=0.006),activated B-cell-like subtype(OR=5.777,P=0.014),Ann Arbor stage Ⅲ to Ⅳ (OR=3.465,P=0.026),bone marrow invasion(OR=3.792,P=0.023)and no response after treatment(OR=5.688,P=0.012)were independent risk factors affecting the prognosis of elderly DLBCL patients after R-CHOP treatment(P<0.05).Conclusion Age>70 years old,activated B-cell-like subtype,Ann Arbor stage Ⅲ to Ⅳ,and non-response after treatment are independent risk factors affecting the prognosis of elderly DLBCL patients after R-CHOP treatment.Risk stratification based on these factors should be performed clinically to improve the prognosis of patients.