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文菁菁, 周佳丽, 刘志彬等.489例弥漫大B细胞淋巴瘤的疗效及影响因素分析.四川大学学报(医学版),2014,45(3):519-523
489例弥漫大B细胞淋巴瘤的疗效及影响因素分析
Clinical Outcome of 489 Patients with Diffuse Large B-cell Lymphoma and Associated Factors
  
中文关键词:  淋巴瘤,弥漫大B细胞淋巴瘤 免疫分型 生发中心 治疗 疗效 影响因素
英文关键词:Lymphoma, diffuse large B-cell lymphoma Immuno-classification Germinal center B-cell Treatment Clinical outcome Factor
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中文摘要:
      目的 分析比较弥漫大B细胞淋巴瘤 (DLBCL)的总体及不同治疗方案疗效,探讨影响治疗方案疗效的因素。 方法 回顾性分析2000年1月至2010年12月在四川大学华西医院诊治的489例初治DLBCL患者临床资料。依据其所接受化疗方案有无利妥昔单抗的不同,分为RCHOP (利妥昔单抗+环磷酰胺,阿霉素/表阿霉素,长春新碱,泼尼松/地塞米松)样组(n=184)和CHOP (环磷酰胺,阿霉素/表阿霉素,长春新碱,泼尼松/地塞米松)样组(n=299),比较两组患者疗效并分析可能的临床影响因素。 结果 RCHOP样组方案有效率高于CHOP样组方案 (84.3% vs.75.6%,P=0.015)。多因素分析显示,脾大、淋巴细胞绝对值(ALC)降低、国际预后指数(IPI) 3~5分及CHOP方案是影响总体疗效的不良因素,ALC降低 〔优势比(OR)=2.060,95%CI:1.159~3.661,P=0.014〕和IPI3~5分 (OR=2.157,95%CI:1.170~3.978,P=0.014)是影响CHOP样组疗效的危险因素,而血红蛋白(HGB)降低 (OR=3.010,95%CI:1.238~7.314,P=0.015)和IPI3~5分 (OR=2.872,95%CI:1.193~6.914,P=0.019)是影响RCHOP样组疗效的危险因素;ALC在0.8×10 9/L~1.0×10 9/L时,RCHOP样组方案有效率高于CHOP样组;Bcl-2+/-、GCB/non-GCB在不同治疗方案间疗效无差异。 结论 RCHOP样组方案疗效优于CHOP样组及二线治疗方案; ALC降低、HGB降低分别是影响CHOP样组及RCHOP样组疗效的独立危险因素。
英文摘要:
      Objective To investigate the clinical outcome of 489 patients with diffuse large B-cell lymphoma (DLBCL), and to identify factors associated with the clinical outcome. Methods Medical records of 489 DLBCL patients admitted to the West China Hospital of Sichuan University from Jan 2000 to Dec 2010 were retrospectively reviewed. The patients were divided into CHOP and RCHOP (rituximab plus CHOP) groups depending on their chemotherapy regimens. The clinical outcomes of the two groups of patients were compared. Results The RCHOP group had a higher response rate than the CHOP group (84.3% vs. 75.6%, P=0.015). The multivariate analysis showed that splenomegaly, low absolute lymphocyte count (ALC), high IPI scores, and CHOP was associate with the low overall-response rate. In the CHOP group, low ALC (OR=2.060,95%CI:1.159-3.661,P=0.014) and high IPI scores (OR=2.157,95%CI:1.170-3.978,P=0.014) were associate with low response rate. In the RCHOP group, anemia (OR=3.010,95%CI:1.238-7.314,P=0.015) and high IPI scores (OR=2.872,95%CI:1.193-6.914,P=0.019) were associate with low response rate. For patients with 0.8×10 9/sup>/L-1.0×10 9/sup>/L ALC, RCHOP therapy was more effective than CHOP. The expression of Bcl-2 and the phenotype of immuno-classification (GCB/non-GCB) were not associated with the difference of overall response rate between the CHOP and RCHOP groups. Conclusion RCHOP therapy increases the overall response rate compared with CHOP alone. Low ALC and anemia is associate with low response rate to CHOP and RCHOP therapy, respectively.
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