利妥昔单抗联合调整剂量EPOCH方案治疗老年中高危B细胞非霍奇金淋巴瘤临床分析

目的 探讨利妥昔单抗联合调整剂量EPOCH方案治疗老年中高危B细胞淋巴瘤患者的临床疗效及安全性。方法 纳入2008—2013年我院收治的老年中高危B细胞非霍奇金淋巴瘤共20例。治疗组8例,接受利妥昔单抗联合调整剂量EPOCH方案化疗（美罗华375mg/m^2 d0,长春新碱0.4mg/m^2＋表柔比星15mg/m^2＋依托泊苷50mg/m^2持续静滴24h d1~4,地塞米松15mg静滴d1~5,环磷酰胺750mg/m^2静滴d5）。对照组12例,接受利妥昔单抗联合CEOP方案化疗（美罗华375mg/m^2 d0,环磷酰胺750mg/m^2 d1,长春地辛4 mg d1,表柔比星60~80 mg/m^2 d1,地塞米松10~15 mg d1~5）。每21~28天为一个疗程。4个疗程后复查全身增强CT或PET-CT以评价治疗效果。结果 治疗组与对照组完全缓解率均为50%,总有效率相近（75%vs 83.3%）,治疗组III度以上的不良反应率均低于对照组,尤其是重症感染的发生率明显降低（0%vs 16.9%,P=0.027）。两组均无1例因化疗副作用终止治疗或死亡。结论 利妥昔单抗联合调整剂量EPOCH方案治疗老年中高危B细胞非霍奇金淋巴瘤,具有较好疗效,可显著降低化疗不良反应率,有助于提高总生存期。

Rituximab and dose-adjusted EPOCH (R-EPOCH) for treatment of elderly B-cell non-Hodgkin lymphomas with intermedian-high risk

Objective To evaluate the efficacy and adverse effects of Rituximab and dose-adjusted EPOCH regimens for elderly B-cell non-Hodgkin lymphoma patients with intermedian-high risk.Methods 20 elderly B-cell non-Hodgkin lymphoma patients were enrolled in the study.8patients were treated by Rituximab and dose-adjusted EPOCH regimens：Rituximab 375mg/m^2 iv d0,Etoposide 50mg/m^2 and Epirubicin 15mg/m^2 and Vincristine 0.4mg/m^2 infused over 24hd1~4,Cyclophosphamide 750mg/m^2 iv d5,Dexamethasone 15 mg iv d1~5.12 patients were treated by Rituximab and CEOP regimens：Rituximab 375mg/m^2 iv d0,Epirubicin 60~80mg/m^2 iv d1,Vindesine 4mg iv d1,Cyclophosphamide 750mg/m^2 iv d1,Dexamethasone 10~15mg iv d1~5.Chemotherapy repeated every 21~28days.Results Complete response was seen in 50%,and partly response in 25% patients on R-EPOCH,compared to 50% and 33.3% on R-CEOP respectively.Grade toxicities incidence were lower in R-EPOCH than in R-CEOP.Conclusion The Rituximab and dose-adjusted EPOCH regimen is effective for elderly B-cell non-Hodgkin lymphoma patients with intermedian-high risk,and well tolerant.