美罗华联合化疗治疗侵袭性B细胞性非霍奇金淋巴瘤的临床分析

背景与目的：环磷酰胺、阿霉素、长春新碱、强的松即CHOP方案为治疗侵袭性B细胞性非霍奇金淋巴瘤(B-NHL)的基本方案．但疗效仍不尽人意。几项研究表明,美罗华对B-NHL有较好的疗效。本研究旨在了解美罗华联合化疗治疗中国人侵袭性B-NHL的疗效及安全性,分析影响疗效的相关因素。方法：回顾性总结我科采用美罗华单药或联合化疗(美罗华用量为375mg／m^2)对75例侵袭性B-NHL患者的疗效,分析年龄、分期、1PI积分和巨块等因素对疗效的影响。结果：采用美罗华单药治疗的初治患者有效率为83．3％(5／6),完全缓解(CR)率66．7％(4／6);美罗华联合化疔对初治患者有效率为90．7％(CR率67．4％)。分期晚(P=0．046)、血清乳酸脱氢酶(LDH)(P=0．024)增高、难治或复发(P=0．009)及合并巨块(P=0．013)的患者疗效明显较差。无治疗相关性死亡。结论：美罗华单药治疗侵袭性B-NHL有一定疗效。美罗华合并化疗可取得较好疗效。分期晚、血清LDH水平较高、难治或复发及合并巨块者疗效较差。

Clinical analysis of rituximab combined with chemotherapy in treating aggressive B-cell non-Hodgkin's lymphoma

BACKGROUND & OBJECTIVE: The efficacy of standard treatment, including cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP regimen), for patients with aggressive B-cell non-Hodgkin's lymphoma (B-NHL) is still unsatisfactory. Rituximab, a chimeric monoclonal antibody against B-cell antigen CD20, has therapeutic activity in B-NHL. This study was to determine efficacy and safety of the combination of rituximab and chemotherapy in treating Chinese patients with aggressive B-NHL, and to analyze influence factors on the response. METHODS: Records of 75 patients with aggressive B-NHL,received infusions of 375 mg/m(2) of rituximab combined with or without chemotherapy in our center,have been retrospectively analyzed. Influence of age, clinical stage, serum level of lactate dehydrogenase (LDH), international prognostic index (IPI) score, and bulk disease on response were evaluated. RESULTS: Response rate of rituximab alone group was 83.3% (5/6)with complete response (CR) rate of 66.7% (4/6). In 43 naive patients, the combination of rituximab and chemotherapy achieved an overall response rate (ORR) of 90.7% with CR rate of 67.4%; while in 26 recurrent or relapsed patients, the combination therapy achieved an ORR of 79.2% with CR rate of 29.2% (7/26), and partial response (PR) rate of 50.0% (13/26), 6 patients had a progressive disease (20.8%). Efficacy of immunochemotherapy was poor on patients with advanced disease(P=0.046), increased serum level of LDH (P=0.024), recurrence or relapse (P=0.009), and bulk disease (P=0.013). All patients can tolerate the treatment. No treatment-related death occurred. CONCLUSION: The addition of rituximab to the chemotherapy regimen increases the response rate and CR rate in Chinese patients with aggressive B-NHL, without a clinically significant increase in toxicity. Patients with advanced disease, higher serum level of LDH, recurrence or relapse, and bulk disease had a poor response.