分割RCHOP方案在老年初治弥漫性大B细胞淋巴瘤中的疗效与安全性分析

陈子琪; 李文琪; 孙金淼; 常宇; 柳喜洋; 张明智; 张蕾

doi:10.12354/j.issn.1000-8179.2024.20240194

分割RCHOP方案在老年初治弥漫性大B细胞淋巴瘤中的疗效与安全性分析

Efficacy and safety of separated R-CHOP in older patients with newly diagnosed diffuse large B-cell lymphoma

摘要

摘要:
目的探究分割利妥昔单抗（rituximab）+环磷酰胺（cyclophosphamide，CTX）+长春新碱（vincristine，VCR）+多柔比星（doxorubicin）+泼尼松（prednisone）的（RCHOP方案）治疗65～80岁初治弥漫性大B细胞淋巴瘤（diffuse large B-cell lymphoma，DLBCL）的疗效与安全性。
方法选取郑州大学第一附属医院2013年4月至2022年9月收治的137例65～80岁初治DLBCL患者，根据化疗方案的不同分为分割RCHOP组、足量RCHOP组和减量RCHOP样组3组。所有患者均以21天为1个周期，治疗4～8个周期。比较3组近期疗效、远期疗效和不良反应发生情况，分析患者无进展生存期（progressiom-free survival，PFS）及总生存期（overall survival，OS）的影响因素。
结果分割RCHOP组、足量RCHOP组和减量RCHOP样组的客观缓解率（overall respond rate，ORR）分别为89.7%、90.3%、86.1%，差异无统计学意义，分割RCHOP组的完全缓解率（complete respond rate，CRR）为64.1%高于减量RCHOP样组（33.3%），差异具有统计学意义（P=0.008），而与足量RCHOP组（66.1%）差别不大。生存曲线分析结果显示分割RCHOP组与足量RCHOP组的PFS和OS均无统计学差异。分割RCHOP组相比减量RCHOP样组改善了PFS（P=0.036），而两组的OS无统计学差异。多因素分析显示，国际预后指数（IPI）和分割RCHOP方案对DLBCL患者PFS均有显著性影响（均P<0.05），IPI评分对DLBCL患者OS具有显著性影响（P<0.001）。分割RCHOP组白细胞减少及3～4级白细胞减少的发生率低于足量RCHOP组，差异具有统计学意义（P=0.007、P=0.012），其余差异无统计学意义。
结论年龄在65～80岁的初治弥漫性大B细胞淋巴瘤患者中，分割RCHOP方案近期疗效、远期疗效及安全性、耐受性均良好。

Abstract:
Objective To investigate the efficacy and safety of separated R-CHOP in older patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).
Methods A total of 137 patients aged 65-80 years newly diagnosed with DLBCL between April 2013 and September 2022 at The First Affiliated Hospital of Zhengzhou University were enrolled. The patients were assigned into separated R-CHOP, full-dose R-CHOP, and reduced R-CHOP-like groups based on their different chemotherapy regimens. All individuals were treated in 21-day cycles for 4–8 cycles. The short-term and long-term efficacies and adverse reactions of the treatments were compared among the three groups, and factors influencing progression-free survival (PFS) and overall survival (OS) were analyzed.
Results The overall response rates (ORR) of patients in the separated R-CHOP, full-dose R-CHOP, and reduced R-CHOP-like groups were 89.7%, 90.3%, and 86.1%, respectively, with no significant differences among them. The complete respond rate (CRR) of the separated R-CHOP group (64.1%) was significantly higher than that of the reduced R-CHOP-like group (33.3%) (P=0.008) but not significantly different from that of the full-dose R-CHOP group (66.1%). Survival curve analysis revealed no significant differences in PFS and OS between the separated and full-dose R-CHOP groups. Although the separated R-CHOP group showed improved PFS compared with the reduced R-CHOP-like group (P=0.036), there was no statistical difference in OS between these two groups. Multivariate analysis revealed that the international prognostic index (IPI) and separated R-CHOP had significant effects on PFS in patients with DLBCL (all P<0.05), whereas only IPI had a significant effect on OS (P<0.001). The incidence of leukopenia and grade 3-4 leukopenia in the separated R-CHOP group was significantly lower than that in the full-dose R-CHOP group (P=0.007, P=0.012), but there was no significant difference with the reduced R-CHOP-like group in this regard.
Conclusions In older patients with newly diagnosed DLBCL, separated R-CHOP showed good efficacy both in the short and long terms and had acceptable safety and tolerability profiles.

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