免疫化疗对弥漫性大B细胞淋巴瘤患者预后评价因子的影响

目前联合利妥昔单克隆抗体的免疫化疗已成为弥漫性大B细胞淋巴瘤(DLBCL)的一线治疗方案。本研究借助当前免疫化疗状况对过去国际预后指数(IPI)及目前报道的几种不同免疫学亚型的预后指导价值进行评估分析。采用回顾性分析方法,分别收集接受免疫化疗的病例(R-CHOP组,51例)和常规化疗的病例(CHOP组,75例)的临床资料,并通过免疫组织化学方法,按目前报道的常用分型方法将两组患者分成不同的免疫学亚型,并探讨两组间不同临床因素、IPI分组及不同免疫学亚型分型对治疗反应率和预后的提示作用。结果表明,CHOP组75例。R-CHOP组的治疗完全反应率(68.6%)明显高于CHOP组(58.7%),年龄因素和IPI风险评分在两组中都有提示预后的作用。Han模型及Muris模型区分不同的免疫学亚型,结果在CHOP组有一定的治疗反应率和预后提示作用,而在R-CHOP组,不同的免疫学亚型间没有明显的治疗反应率和预后差异。结论:IPI评分在免疫化疗中仍具有重要的预后评价作用,但利妥昔单克隆抗体的应用可能会使基因学差异导致的预后影响减弱甚至消失。免疫化疗的应用提高了DLBCL的治疗反应率及生存率。

Impact of immunochemotherapy on prognostic factors in diffuse large B-cell lymphoma patients

The international prognostic index (IPI) has been established as one of the best predictors of outcome, and several different immunologic subtypes have been established as independent predictors of diffuse large B-cell lymphoma (DLBCL). This study was aimed to reassess and re-evaluate the useful value of these prognostic predictors in patients treated with immunochemotherapy. A retrospective analysis of clinical records of immuno-chemotherapeutic (retuxmab + CHOP, R-CHOP) and route chemotherapeutic (CHOP) groups was carried out. Standard two-step method of immunohistochemical staining was used to assess the expression of CD10, MUM-1, BCL-6 and BCL-2. The different classification models (Han's algorithm and Muris model) were performed for patients with DLBCL according to the immunohistochemical staining results in both R-CHOP and CHOP regimen groups. Then the data of remission and overall survival rate in different groups were analyzed to investigate the effect of these prognostic factors. Total 126 de novo DLBCL patients were collected in this study, including 51 patients with treatment of R-CHOP and the other 75 patients with treatment of CHOP. The results showed that the R-CHOP group had higher complete remission rate (68.8) than CHOP group (58.7). The patients with IPI score ≤ 2 had significantly higher overall response rate and overall survival rates than the patients with IPI scores > 2 in both groups. The survival rates of different subtypes in Han's and Muris models were not different from each other in R-CHOP group, but were obvious different from each other in CHOP group. It is concluded that IPI is still effective and predictive for identification of different risk groups. Immunochemotherapy can improve the remission and overall survival rate of DLBCL, but weaken the effect of outcome predictor.