美罗华联合CHOP方案与CHOP方案治疗初治弥漫性大B细胞淋巴瘤的临床对比研究

背景与目的:CHOP方案是治疗弥漫性大B细胞淋巴瘤的标准方案。美罗华是一种抗CD20单克隆抗体,对弥漫性大B细胞淋巴瘤有效。本研究中比较美罗华联合CHOP方案和单用CHOP方案治疗初治的弥漫性大B细胞淋巴瘤的疗效和不良反应。方法:采用同期非随机对照的前瞻性研究方法,将72例初治的弥漫性大B细胞淋巴瘤患者分为联合组和CHOP组。联合组34例,采用CHOP方案(环磷酰胺加阿霉素加长春新碱加强的松)加美罗华(375mg/m2,于每周期化疗前2天静脉滴注1次)治疗;CHOP组38例,单用CHOP方案化疗。两组均每3周为一个循环周期,6个周期后比较两组的疗效及不良反应。结果:联合组完全缓解23例,部分缓解7例,总有效率为93.8%(30/32);CHOP组完全缓解19例,部分缓解8例,总有效率为75.0%(27/36),两组疗效差异有显著性(P<0.05);联合组和CHOP组1年的无进展生存率分别为81.2%和52.8%,总生存率为93.8%和75.0%,联合组均显著优于CHOP组(P<0.05)。联合组的不良反应主要为发热等输注相关的不良反应,以及骨髓抑制等化疗相关的血液学不良反应,其中输注相关的不良反应轻微,患者均可耐受,而骨髓抑制情况与CHOP组类似。结论:美罗华联合CHOP方案能够提高CHOP方案治疗初治弥漫性大B细胞淋巴瘤的疗效,而毒性反应类似,可作为该病的一线治疗方案。

Comparison of rituximab plus CHOP regimen and CHOP regimen alone for treatment of newly diagnosed patients with diffuse large B-cell lymphoma

BACKGROUND & OBJECTIVE: CHOP regimen is the standard treatment for patients with diffuse large B-cell lymphoma. Rituximab, an anti-CD20 monoclonal antibody, is effective in treating diffuse large B-cell lymphoma. This study was conducted to compare the efficacy of rituximab plus CHOP and CHOP alone on newly diagnosed patients with diffuse large B-cell lymphoma, and analyze their toxicities. METHODS: A total of 72 newly diagnosed patients with diffuse large B-cell lymphoma were divided into 2 groups prospectively with concurrent control: 34 received CHOP plus rituximab (375 mg/m2, 2 days before each course) (combination group), 38 received CHOP alone. Each course lasted 3 weeks. All cases were evaluated after 6 courses. RESULTS: The total response rate in combination group was 93.8% (30/32), among which complete remission was seen in 23 patients and partial remission was seen in 7 patients; while the total response rate in CHOP group was 75.0% (27/36), among which complete remission was seen in 19 patients and partial remission was seen in 8 patients. The therapeutic efficacy was significantly better in combination group than in CHOP group (P<0.05). The 1-year progression-freely and overall survival rates were significantly higher in combination group than in CHOP group (81.2% vs. 52.8%, 93.8% vs. 75.0%, P<0.05). The major adverse events in combination group were infusion-related response which could be well tolerated, and hematological toxicities which were similar to those in CHOP group. CONCLUSIONS: Rituximab increases the therapeutic efficacy of CHOP regimen on newly diagnosed patients with diffuse large B-cell lymphoma, without a clinically significant increase in toxicity. Rituximab plus CHOP can be used as a first-line therapy of diffuse large B-cell lymphoma.