联合化疗方案治疗初治滤泡性淋巴瘤患者的生存、疗效及安全性

目的 评估不同联合化疗方案治疗的初治滤泡性淋巴瘤（FL）患者的疗效、预后和安全性.方法 回顾性分析62例初治FL患者资料,分析其生存情况,比较不同联合化疗方案的疗效及患者不良反应.结果 经初始治疗达完全缓解（CR）的患者占80.0％（44/55）,其中23.6％（13/55）持续CR≥5年.全组患者10年总生存（OS）率为77.8％,复发率为34.5％,复发患者OS率较无复发者明显降低（93.8％比61.6％,P=0.012）.采用FC/FMD方案治疗组较采用CHOP样方案治疗组患者的无病生存（DFS）率和无进展生存（PFS）率均明显升高（80.0％比21.1％和80.0％比29.2％,P＜0.05）,但加用利妥昔单抗后二者差异无统计学意义（88.9％比72.7％和90.0％比73.5％,P＞0.05）.应用利妥昔单抗联合化疗的患者OS率、DFS率和PFS率均较未应用组升高（96.4％、79.2％和79.2％比82.9％、39.3％和44.5％,P＜0.05）;应用氟达拉滨联合化疗的患者DFS率和PFS率均较未应用组明显升高（86.2％比49.4％,87.1％比52.7 ％,P＜ 0.05）,但OS率差异无统计学意义（92.9％比89.1％,P＞0.05）.联合化疗的主要不良反应为血液学毒性、感染、恶心、呕吐及肝功能异常.氟达拉滨联合方案的血液学毒性较强,但可耐受.结论 初始联合化疗后,FL的CR率较高,部分患者是有可能通过化疗达到彻底治愈的.利妥昔单抗可明显延长患者OS时间.FC/FMD方案与CHOP样方案相比,可延长患者PFS时间,加用利妥昔单抗后,两方案疗效差异无统计学意义.系统化疗的毒副作用可耐受.

Survival status,efficacy and safety of combination chemotherapies in previously untreated patients with follicular lymphoma

Objective To evaluate the survival status and efficacy,prognosis and safety of several combined chemotherapies in previously untreated patients with follicular lymphoma （FL）.Methods Clinical data of 62 previously untreated FL patients were analyzed retrospectively,in order to analyse survival status and to compare the efficacy and safety of different combined chemotherapies.Results The percent of FL patients achieved complete response （CR） after initial therapy was 80.0 % （44/55）,while achieved for more than 5 years accounted for 23.6 % （13/55）.Ten-year overall survival （OS） rate was 77.8 %.The relapse rate was 34.5 %,and the OS rate in patients with recurrence was significantly lower than in non-recurrence patients （93.8 % vs 61.6 %,P =0.012）.The disease-free survival （DFS） and progression-free survival （PFS）rates in FC/FMD （fludarabine,cyclophosphamide/fludarabine,mitoxantrone,dexamethasone） group comparing with CHOP （cyclophosphamide,epirubicin,vincristine,prednisone）-like group were significantly higher （80.0 % vs 21.1% and 80.0 % vs 29.2 %,P 〈 0.05）,but the differences had no statistical significance when adding rituximab （88.9 % vs 72.7 % and 90.0 % vs 73.5 %,P 〉 0.05）.The OS,DFS and PFS rates in rituximab group were higher than those in the group without it （96.4 %,79.2 % and 79.2 % vs 82.9 %,39.3 % and 44.5 %,P 〈 0.05）.The DFS and PFS rates in fludarabine group comparing with the group without it were significantly higher （86.2 % vs 49.4 %,87.1% vs 52.7 %,P 〈 0.05）,but the differences between OS rates had no statistical significance （92.9 % vs 89.1%,P 〉 0.05）.The major adverse effects were hematologic toxicity,infection,nausea/vomiting and abnormal liver function.The hematologic toxicity of chemotherapies including fludarabine was stronger,but well-tolerated.Conclusion With initial combined chemotherapies,the CR rate of FL could receive a higher level.It is considered that chemotherapy might cure a part of FL patients thoroughly.Rituximab could increase the OS time significantly.FC/FMD regimen could increase the PFS time,comparing with CHOP-like regimen,while the difference has no statistical significance when adding rituximab.Systemic chemotherapies are well tolerated.