利妥昔单抗联合CHOP与单用CHOP方案治疗初治弥漫大B细胞型淋巴瘤的对比研究

目的：比较利妥昔单抗（商品名：美罗华）联合CHOP（环磷酰胺,阿霉素,长春新碱和泼尼松）与单用CHOP方案化疗治疗弥漫大B细胞淋巴瘤（diffuse large B cell lymphoma,DLBCL）的临床疗效。方法：根据患者的意愿,49例DLBCL患者分别接受6疗程CHOP方案或CHOP加利妥昔单抗方案化疗,每3周1疗程,共6个疗程。结果：R-CHOP组的CR率高于CHOP组,但差异无统计学意义（82.6%VS 65.4%,P=0.173）。中位随访时间为35月（4-66月）,R-CHOP组及CHOP组的3年OS分别为75.0%±19.6%,54.9%±20.4%,P=0.043;而3年EFS分别为69.7%±20.9%,45.8%±20.6%,P=0.029。R-CHOP组的3年OS及EFS优于CHOP组,差异有统计学意义。两组患者的不良反应无明显差别。结论：与单用CHOP方案相比,利妥昔单抗联合CHOP方案明显提高DLBCL患者的EFS及OS,而不良反应无明显增加。     

利妥昔单抗联合CHOP方案治疗弥漫大B细胞淋巴瘤临床疗效

目的：观察利妥昔单抗联合 CHOP 方案治疗弥漫大 B 细胞淋巴瘤（DLBCL）的临床疗效。方法：分析39例2006年1月-2012年6月我院住院确诊为 DLBCL 患者的临床资料,所有患者均采用 R - CHOP 方案治疗,每3周1疗程,共4-6疗程。结果：39例患者中16例获完全缓解（ CR）,CR 率为41.0%,12例获部分缓解（ PR）,PR 率为30.8%,总有效率（CR ＋ PR）为71.8%（28/39）,好转（MR）和无变化（NC）各4例（10.3%）,疾病进展（PD）3例（7.7%）;单因素分析发现,CR 及 PR 率与性别、年龄、ECOG 评分、结外病变数目无关（P ﹥0.05）。但与临床分期、LDH 水平、β2- MG 水平、B 细胞来源（ GCB 型、Non - GCB 型）及有无大包块病变有关（均 P ﹤0.05）,患者28个月的无进展生存时间（PFS）和总生存时间（OS）分别为（54.8±5.2）%和（65.4±5.7）%。结论：利妥昔单抗联合 R - CHOP 方案治疗弥漫大 B 细胞淋巴瘤近期疗效好,不良反应轻微,可作为该病的一线治疗方案。     

利妥昔单抗联合CHOP方案治疗B细胞非霍奇金淋巴瘤的临床分析

目的 观察利妥昔单抗联合CHOP方案治疗CD20阳性B细胞非霍奇金淋巴瘤的临床疗效及毒副反应.方法 8例B细胞非霍奇金淋巴瘤均采用利妥昔单抗联合化疗,利妥昔单抗375 ms/m2于每1周期化疗前1天静脉滴注,每3周为1疗程,4～6周期后评价疗效及毒副反应.结果 8例患者中,CR 7例,PR 1例,总有效率100%.主要...     

利妥昔单抗联合CHOP方案对弥漫型大B细胞淋巴瘤的疗效及影响因素

目的探讨利妥昔单抗联合CHOP方案对弥漫型大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的疗效,观察影响化疗疗效的相关因素。方法本组选择我院2006年1月至2011年1月收入的DLBCL患者17例,患者给予利妥昔单抗联合CHOP方案治疗。观察化疗后疗效及淋巴结亚群改变情况,收集患者的性别、年龄、PS评分、Ann Arbor分期、结外浸润情况、LDH水平、体力状态(PS)评分、B症状、血红蛋白及T细胞浸润等相关情况,观察其对化疗的相关影响。结果本组所有17例患者完成治疗,治疗后疗效评估显示CR7例,PR6例,SD3例,PD1例,治疗有效率为76.4%(13/17)。影响化疗疗效相关因素分析中显示,血清LDH水平、PS评分、AnnArbor分期为影响患者化疗疗效的相关因素,P0.05。结论利妥昔单抗联合CHOP对弥漫型大B细胞淋巴瘤疗效显著,其中PS评分低、Ann Arbor分期低、血清LDH水平正常的患者化疗疗效相对较好。     

利妥昔单抗联合CHOP治疗弥漫大B细胞性非霍奇金淋巴瘤的临床观察

目的 比较利妥昔单抗联合 CHOP 方案和单用 CHOP 方案治疗 B 细胞非霍奇金淋巴瘤的疗效和毒副反应.方法 将26例B细胞性非霍奇金淋巴瘤(NHL)分为两组,一组采用利妥昔单抗联合 CHOP 方案.利妥昔单抗用量为375 mg/m2,每个疗程的第1天使用;另一组单用 CHOP 方案.结果 利妥昔单抗联合化疗组的完全缓解率(CR)46.2%,总有效率(OR)76.9%;CHOP 组 CR 率38.5%,OR 率61.5%,两组疗效比较差异有统计学意义.治疗后的毒副反应比较差异无统计学意义.结论 利妥昔单抗和 CHOP方案联用能明显提高 B 细胞 NHL 患者的 CR 率和 OR 率,未增加毒副反应,有望成为 B 细胞 NHL 的一线治疗方案.     

利妥昔单抗联合CHOP方案治疗B细胞非霍奇金淋巴瘤的疗效观察

目的探讨利妥昔单抗联合环磷酰胺+多柔比星+长春新碱+泼尼松(CHOP方案)治疗B细胞非霍奇金淋巴瘤的疗效及安全性。方法选取2018年10月至2020年12月间湘乡市人民医院收治的76例B细胞非霍奇金淋巴瘤患者,采用单双号抽签方式分为观察组和对照组,每组38例。对照组患者采用常规CHOP方案治疗,观察组患者采用利妥昔单抗联合CHOP方案治疗,比较两组患者疾病控制情况、远期生存率及治疗期间不良反应。结果观察组患者治疗有效率为86.8%,高于对照组的65.8%,差异有统计学意义(P <0.05)。观察组患者1年和3年无进展生存时间(PFS)和总生存时间(OS)均高于对照组,差异均有统计学意义(均P <0.05);观察组患者5年PFS和OS均高于对照组,但差异无统计学意义(P> 0.05)。两组患者白细胞下降、血小板减少、恶心呕吐、脱发及贫血等不良反应发生率比较,差异无统计学意义(P> 0.05)。结论 B细胞非霍奇金淋巴瘤患者采用利妥昔单抗联合CHOP方案治疗,近期效果较好,可提高远期生存率,且不增加不良反应,临床值得推广。     

利妥昔单抗联合CEOP方案治疗侵袭性B细胞淋巴瘤的近期疗效

目的：研究利妥昔单抗(美罗华)联合CEOP方案治疗侵袭性B细胞淋巴瘤的疗效及其不良反应。方法：21例侵袭性B细胞淋巴瘤，中数年龄48岁(15～68岁)，使用利妥昔单抗联合CEOP方案，利妥昔单抗375mg／m^2第1天，环磷酰胺750mg／m^2第3天，表柔比星60mg／m^2第3天，长春新碱2mg第3天和强的松40mg／m^2第3～7天。结果：完全缓解16例(76．2％)，部分缓解3例(14．2％)，稳定1例(4．8％)和进展1例(4．8％)，有效率为90．5％。19例有效患者随访2～15月，1例甲状腺淋巴瘤完全缓解14月后复发，其余患者均处于缓解中。21例患者87个次治疗中仅观察到1例利妥昔单抗输注相关反应，血液学毒性主要是白细胞减少和中性粒细胞减少，Ⅲ～Ⅳ度中性粒细胞减少5例(23．8％)，中性粒细胞减少性发热1例。除脱发为Ⅲ度外，其他非血液学毒性均为Ⅰ～Ⅱ度。结论：利妥昔单抗联合CEOP方案治疗侵袭性B细胞淋巴瘤疗效高而不良反应轻，有望成为标准治疗。     

利妥昔单抗联合CHOP 方案治疗6例非霍奇金淋巴瘤

 我院自2003年2月至2004年5月应用利妥昔单抗联合CHOP方案治疗6例B细胞性的非霍奇金淋巴瘤，取得较好疗效，现将结果报告如下。     

弥漫大B细胞性淋巴瘤临床病理特点与利妥昔单抗疗效的关系

目的 探讨弥漫大B细胞性淋巴瘤(DLBCL) 临床病理特点与利妥昔单抗疗效之间的关系.方法 回顾性分析69例采用利妥昔单抗联合化疗治疗DLBCL患者的临床资料,探讨DLBCL临床病理特征对疗效的影响.应用免疫组化SP法检测Bcl-2、survivin及bax蛋白的表达,分析其表达与利妥昔单抗疗效之间的关系.结果 采用利妥昔单抗联合化疗治疗初治DLBCL患者,有效率为90.7%,完全缓解(CR)率为69.8%;难治或复发患者的有效率为80.8%,CR率为30.8%.分期晚(P=0.046)、血清乳酸脱氢酶(LDH)水平较高(P=0.024)、难治或复发(P=0.009)以及合并大肿块(P=0.013)的患者疗效明显差.Bcl-2表达阳性者的疗效明显好于阴性者(P=0.04);bax和survivin的表达则与疗效无关(P>0.05).结论 利妥昔单抗联合化疗治疗DLBCL患者,有效率和CR率较高,且患者耐受性良好.但分期较晚、LDH水平较高、难治或复发、合并大肿块以及Bcl-2表达阴性患者的疗效较差.     

利妥昔单抗联合CHOP方案治疗弥漫性大B细胞淋巴瘤的临床病理学研究

 目的　探讨利妥昔单抗（商品名：美罗华）联合CHOP方案对弥漫性大B细胞淋巴瘤（DLBCL）患者预后的影响。方法　收集北京大学基础医学院血液病理研究室确诊的DLBCL患者156例,免疫组织化学方法检测bcl-2、CD10、bcl-6和MUM-1表达情况。根据Hans模型将患者区分为生发中心B细胞样细胞起源组（GCB）和非生发中心B细胞样细胞起源组（non-GCB）;利用Muris分型将DLBCL患者分为低临床风险组（1组）和高临床风险组（2组）;将使用利妥昔单抗联合CHOP方案治疗的患者设为研究组,未使用利妥昔单抗治疗的患者设为对照组。随访全部病例的治疗过程和预后情况。采用SAS8.2统计软件对所得资料进行χ2 检验、对数线性模型及Life Table 生存分析。结果　研究组的30例患者,3年总体生存率78.3 %,对照组的126例患者3年总体生存率53.4 %,研究组患者整体预后情况明显好于对照组,二者之间差异有统计学意义（P＜0.05）。研究组和对照组中,Hans模型所区分的不同起源组之间预后差异无统计学意义（P＞0.05）。研究组中Muris模型所区分的1组预后与2组之间差异无统计学意义（P＞0.05）;而对照组中,Muris模型所区分的1组预后明显较2组好,差异有统计学意义（P＜0.05）。bcl-2蛋白表达与对照组患者的预后不良具有较强相关性,而与研究组预后无明显相关。结论　使用利妥昔单抗联合CHOP方案化疗能够显著提高DLBCL患者的生存率。利妥昔单抗使用后,bcl-2蛋白表达及Muris模型分组对DLBCL的预后提示作用明显减弱。     

A salvage chemotherapy of R‐P‐IMVP16/CBDCA consisting of rituximab,methylprednisolone, ifosfamide,methotrexate, etoposide,and carboplatin for patients with diffuse large B cell lymphoma who had previously received R‐CHOP therapy as first‐line chemotherapy

We have reported the efficacy of the salvage chemotherapy P‐IMVP16/CBDCA for patients with diffuse large B cell lymphoma (DLBCL) who had previously received CHOP before the availability of rituximab (R). Here, we confirmed the efficacy of R combined with P‐IMVP16/CBDCA as a salvage chemotherapy for patients with DLBCL, who had previously received R‐CHOP. We retrospectively analysed 59 patients with relapse or refractory DLBCL (38 male patients and 21 female patients) presenting between June 2004 and June 2013. The patients received R 375 mg/m² on day 1, methylprednisolone 1000 mg/body for 3 days (from day 3 to day 5), ifosfamide 1000 mg/m² for 5 days (from day 3 to day 7), methotrexate 30 mg/m² on day 5 and day 12, etoposide 80 mg/m² for 3 days (from day 3 to day 5), and carboplatin 300 mg/m² on day 3 every 21 days. Patients aged 70 years or older were given 75% of the standard dose. The overall response rate (complete response + partial response) was 64.4%. The 2‐year overall survival rate was 55.3%. The 2‐year progression free survival rate was 34.7%. The 2‐year overall survival rate was 61.5% for the relapse patients, and 15.6% for the refractory patients (p < 0.0001). One patient died because of sepsis related to the treatment regimen. Non‐hematological adverse effects were mild and tolerable. The R‐P‐IMVP‐16/CBDCA regimen displayed a significant activity in relapsed DLBCL, with acceptable toxicity, and should be considered a candidate for salvage chemotherapy. Copyright © 2016 John Wiley & Sons, Ltd.     

Long-term update of a phase II study of rituximab in combination with CHOP chemotherapy in patients with previously untreated, aggressive non-Hodgkin's lymphoma

The present study aimed to determine the long-term safety and efficacy of chimeric anti-CD 20 antibody rituxan (rituximab, Biogen IDEC, San Diego, CA, USA; Genentech, South San Francisco, CA, USA) in combination with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy in previously untreated patients with aggressive non-Hodgkin's lymphoma (NHL). Thirty-three patients with previously untreated aggressive B-cell NHL received six infusions of rituximab (375 mg/m² per dose) on day 1 of each cycle of CHOP chemotherapy, given on day 3 of each cycle of therapy. Currently, the patients now have a median follow-up of 63 months (range 34 - 82 months). The overall response (OR) rate was 94% and the complete response (CR) rate was 61% at the end of therapy. Of the 33 patients, 2 patients experienced disease progression and subsequently died of their disease, 2 patients experienced disease progression but were alive at last follow-up following additional therapy, and 2 patients died without experiencing disease progression: one due to a cerebral vascular accident at 9 months after therapy and a second patient due to small cell lung carcinoma at 55 months. The 5-year survival rate was 88% (95% confidence interval (CI) 72 - 97) and the 5-year progression-free survival was 82% (95% CI 64 - 93). There were no long-term adverse events noted directly related to the rituximab. The long-term follow-up of patients in this phase II trial of rituximab with CHOP chemotherapy for previously untreated aggressive NHL demonstrates a high response rate, which remains very durable with high 5-year overall and progression-free survivals.     

Combination of rituximab with chemotherapy in diffuse large B-cell lymphoma. Evaluation in daily practice before and after approval of rituximab in this indication

Randomized trials have demonstrated improved outcome from adding rituximab to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for patients with diffuse large B-cell lymphoma (DLBCL). This retrospective study compared the outcomes of 224 patients with DLBCL treated in our institution before (Period 1, 1996-2002) and after (Period 2, 2002-2005) approval of rituximab in this indication to evaluate the impact of the drug in daily practice in unselected patients receiving different types of chemotherapy. We treated 131 patients in Period 1 versus 93 in Period 2 (median follow-up, 75 and 29 months, respectively) with no difference in patient characteristics between the two periods. Event-free and overall survivals (EFS and OS) were significantly improved in Period 2 for elderly patients and a significant shift in the selection of regimens was observed at the time when rituximab became available. More patients received the CHOP regimen in Period 2 than in Period 1 (82 vs. 57%, p < 0.007) with CHOP being substituted for epirubicin-based regimens. In younger patients treated mostly with the ACVBP regimen (doxorubicin, cyclophosphamide, vindesine, bleomycin, prednisone) these differences were not observed, suggesting that combination of rituximab with dose-dense chemotherapy may deserve further evaluation in this age group.     

Matched-pair analysis comparing the outcomes of primary breast and nodal diffuse large B-cell lymphoma in patients treated with rituximab plus chemotherapy

Primary breast diffuse large B-cell lymphoma (DLBCL) is an extremely rare presentation of non-Hodgkin's lymphoma that has been associated with poorer clinical outcomes compared with nodal DLBCL in the pre-rituximab era. The aim of this study was to investigate the impact of rituximab on clinical outcomes in patients with primary breast DLBCL. Data from 25 female patients with primary breast DLBCL receiving rituximab plus chemotherapy were matched to 75 female patients (1:3) with nodal DLBCL by following five established prognostic factors (age, Ann Arbor stage, Eastern Cooperative Oncology Group performance status, serum lactate dehydrogenase level and B symptoms). Overall survival (OS) was similar between primary breast and nodal DLBCL groups (3-year OS rate, 82.2% vs. 90.7%, respectively; p = 0.345). In the analysis of immunohistochemically defined prognostic subgroups, 19 of 20 available cases in the primary breast DLBCL group displayed a non-germinal center (GC) phenotype. Compared with patterns of recurrence, extranodal progression in the breast or central nervous system (CNS) was significantly higher in the primary breast DLBCL group than in the nodal DLBCL group (p < 0.001). Additionally, the stage-modified International Prognostic Index was the only independent prognostic factor for OS in this population. This suggests that clinical outcomes of primary breast DLBCL might no longer be inferior to those of nodal DLBCL in the rituximab era, which might be associated with the intrinsic biologic characteristics of the non-GC phenotype. However, despite including rituximab, extranodal progression in the breast or CNS was problematic. This study was registered at www.clinicaltrials.gov as no. NCT01266668.     

Multicentre phase II study of CyclOBEAP plus rituximab in patients with diffuse large B‐cell lymphoma

The R‐CHOP regimen has been found to improve the outcome of diffuse large B‐cell lymphoma (DLBCL). However, it does not provide a satisfactory treatment outcome in the high‐risk group. We previously administered the CyclOBEAP regimen to patients with DLBCL, and reported its safety and efficacy. The R‐CyclOBEAP regimen was administered over a total period of 12 weeks, and rituximab 375 mg/m² was given every 2 weeks. There were 101 eligible patients. CR was achieved in 96 patients (95%). The 5‐year overall survival (OS) rate was 85% and progression‐free survival (PFS) rate was 76%. When the patients were divided according to the IPI, the 5‐year OS and PFS rates did not significantly differ among the risk groups. The 5‐year PFS of the germinal centre B‐cell group was 80% and that of the non‐GCB group was 74% (NS). Univariate analysis showed that the presence of B symptoms, extranodal lesions ≧2, and sIL‐2R were significant poor prognostic factors. Grade 4 neutropenia was observed in 91 patients and thrombocytopenia in 9 patients. The addition of rituximab to CyclOBEAP therapy may enhance the effect of CyclOBEAP therapy for DLBCL. Copyright © 2010 John Wiley & Sons, Ltd.     

Irinotecan plus cisplatin and dexamethasone (ICD) combination chemotherapy for patients with diffuse large B-cell lymphoma previously treated with Rituximab plus CHOP

PURPOSE: The therapeutic strategy for relapsed or refractory patients with diffuse large B-cell lymphoma (DLBL) remains challenging yet. Salvage therapy has been tried for these patients according to their clinical status. We studied ICD (irinotecan, cisplatin and dexamethasone) regimen as salvage chemotherapy for DLBL patients previously treated with RCHOP. METHODS: Between February 2005 and May 2006, 15 patients were treated prospectively with ICD chemotherapy; irinotecan 65 mg/m(2)/day on days 1 and 8, cisplatin 30 mg/m(2)/day on days 1 and 8, and dexamethasone 40 mg/day on days 1-2 and 8-9. This schedule was planned to repeat every 3 weeks until disease progression, severe toxicity or stem cell transplantation. RESULTS: Of the 14 patients evaluable for response, 3 patients achieved CR, 7 patients PR, with 1 SD and 3 PD; overall response rate 71% (10/14; 95% confidence interval, 47-95%). The median progression free survival (PFS) and event free survival (EFS) were 113 (range 21-493+) and 77 (range 21-324+) days, respectively. The median overall survival was 267 (range 31-493+) days. Grade 3/4 neutropenia and grade 3 neutropenic fever were observed in 67% (22/33) and 18% (6/33) of cycles, respectively. There were 20% of grade 3/4 nausea and diarrhea observed. CONCLUSIONS: The ICD regimen with current schedule showed high response rate for DLBL patients previously treated with RCHOP. But the high incidence of neutropenia led to delay of subsequent cycles causing dose intensity reduced, which seems to be related with short PFS and EFS.     

Prognostic impact of extranodal involvement in diffuse large B-cell lymphoma in the rituximab era

BACKGROUND:

Extranodal involvement is considered a poor prognostic factor for patients with diffuse large B‐cell lymphoma (DLBCL); however, the prognostic impact of specific sites of involvement has not been fully elucidated.

METHODS:

The authors retrospectively analyzed 1221 patients treated uniformly with standard R‐CHOP therapy between 2003 and 2006. Patients with distinct forms of DLBCL such as intravascular lymphoma, primary effusion lymphoma, pyothorax‐associated lymphoma, primary central nervous system lymphoma, and intraocular lymphoma were also excluded. The authors evaluated 26 extranodal sites of involvement with respect to prognostic impact. The median age was 64 years (range, 15‐91 years).

RESULTS:

Univariate analysis revealed that patients with involvement of specific extranodal sites had significantly worse overall survival (OS) than did patients without such involvement; these sites included nasal cavity, paranasal sinus, lung, pleura, small intestine, peritoneum, liver, pancreas, stomach, spleen, adrenal gland, testis, bone, bone marrow, peripheral blood, skin, and subcutaneous tissue. Patients with Waldeyer ring involvement had significantly better OS. Multivariate analysis revealed that patients with the involvement of the pleura (P < .001), small intestine (P = .015), peritoneum (P = .002), adrenal gland (P < .001), testis (P = .005), bone marrow (P < .001), and peripheral blood (P = .002) had significantly worse OS, whereas those with Waldeyer ring involvement had significantly better OS (P = .038). Subgroup analysis with the nodal and/or Waldeyer patient group also showed prognostic impact of Waldeyer ring by multivariate analysis (relative risk, 0.3; P = .04).

CONCLUSIONS:

Extranodal involvement affects the prognosis of patients undergoing R‐CHOP therapy for DLBCL. Cancer 2012. © 2011 American Cancer Society.     

Rituximab in Combination with CHOP, an Effective and Well-tolerated Salvage Regimen for Diffuse Large B-Cell Lymphoma

OBJECTIVE To evaluate the clinical effect of the R-CHOP regimen (rituximab in combination with cyclophosphamide, epirubicin, vincristine and prednisone) in treating refractory or relapsed diffuse large B-cell lymphoma (DLBCL), as a salvage therapy for DLBCL. METHODS Eighteen patients with refractory or relapsed DLBCL who were treated with the R-CHOP regimen from 2001 to 2006 in hospitals in Jilin Province were analyzed retrospectively. The response rate, change of serum lactate dehydrogenase (LDH), time to progression (TTP) and toxicity were observed. RESULTS The R-CHOP regimen can achieve a higher response rate, decrease serum LDH to a larger extent and obtain longer TTP than a con- ventional secondary regimen. The main adverse effects were similar to con- ventional chemotherapy. CONCLUSION The R-CHOP regimen is one of the most effective sec- ondary therapies for DLBCL.