ABVD方案治疗复发/难治弥漫大B细胞淋巴瘤的临床分析

目的研究吡柔比星+博来霉素+长春新碱+氮烯咪胺(ABVD)方案挽救化疗复发/难治弥漫大B细胞淋巴瘤(DLBCL)的疗效和安全性。方法回顾性分析2011年1月至2017年3月收治的无法接受强烈化疗或自体造血干细胞移植(ASCT),接受ABVD方案挽救化疗的复发/难治DLBCL患者35例。ABVD方案如下:吡柔比星25 mg/m^2静滴d_1、d₁₅,博来霉素10 mg/m^2静滴d_1、d₁₅,长春新碱1.4 mg/m^2静滴d_1、d₁₅,氮烯咪胺375 mg/m^2静滴d_1、d₁₅。28天为1个周期,化疗6个周期。观察近期疗效、1年生存率、总生存时间(OS)和不良反应。结果随访截止于2019年3月,中位随访14.4个月。全组患者经ABVD方案挽救化疗后,获CR 8例、PR 17例、SD 6例、PD 4例;有效率(RR)为71.5%,疾病控制率(DCR)为88.6%。中位缓解持续时间为3.5个月(95%CI:3.13~3.87个月),1年生存率为45.7%,中位OS为13.0个月(95%CI:11.90~14.10个月)。25例国际预后指数(IPI)评分低中危组患者(0~2分)的RR、DCR、1年生存率、中位OS分别为84.0%、100.0%、60.0%和14.0个月(95%CI:12.71~15.30个月),均高于10例中高危组患者(3~4分)的40.0%、60.0%、10.0%和6.0个月(95%CI:3.65~8.35个月),差异均有统计学意义(P<0.05);而不同CD5表达情况以及ABVD方案不同治疗线程的患者上述指标的差异均无统计学意义(P>0.05)。全组主要不良反应为骨髓抑制和消化道反应,发生率分别为61.8%(24/35)和14.3%(5/35),以1~2级为主。结论 ABVD方案对多次化疗、无法接受强烈化疗或ASCT的低中危型复发/难治DLBCL疗效可靠、耐受性好,值得进一步临床研究。

Clinical analysis of ABVD salvage regimen in relapsed/refractory diffuse large B-cell lymphoma

Objective To evaluate the efficacy and safety of pirarubicin+bleomycin+vincristine+dacarbazine(ABVD)regimen as salvage treatment for relapsed/refractory diffuse large B-cell lymphoma(DLBCL).Methods A retrospective analysis was performed on 35 relapsed/refractory DLBCL patients who were unable to receive intense chemotherapy or autologous hematopoietic stem cell transplantation(ASCT),and were treated with ABVD salvage regimen from January 2011 to March 2017.ABVD regimen was given as follow:pirarubicin 25 mg/m^2iv d 1,d 15;bleomycin 10mg/m^2 iv d 1,d 15;vincristine 1.4 mg/m^2 iv d 1,d 15;dacarbazine 375 mg/m^2 iv d 1,d 15.Twenty-eight days was a cycle for 6 cycles.Short-term efficacy,1-year overall survival rate,overall survival and adverse events were observed.Results Until March 2019,the median follow-up period was 14.4 months.Among the 35 patients treated with ABVD salvage regimen,there were 8 cases of CR,17 cases of PR,6 cases of SD and 4 cases of PD.The response rate(RR)was 71.5%,and the disease control rate(DCR)was 88.6%.The median duration of response,1-year overall survival rate,and median OS were 3.5(95%CI:3.13-3.87)months,45.7%,and 13.0(95%CI:11.90-14.10)months respectively.The RR,DCR,1-year overall survival rate and median OS of low-intermediate IPI(1-2 score)group were 84.0%,100.0%,60.0%and 14.0(95%CI:12.71-15.30)months respectively,higher than 40.0%,60.0%,10.0%and 6.0(95%CI:3.65-8.35)months in intermediate-high IPI(3-4 score)group with statistical significance(P<0.05).However,the difference of the above indexes for different CD5 expression or the application of ABVD regimen had no statistical significance(P>0.05).The main adverse events were myelosuppression and digestive tract reactions with the incidence rates of 61.8%(24/35)and 14.3%(5/35),mainly in grade 1-2.Conclusion ABVD regimen is reliable and well-tolerated in low-intermediate risk relapsed/refractory DLBCL patients after multiple chemotherapy who were not suitable for intense chemotherapy or ASCT,and worthy further study.