联合利妥昔单抗治疗对高龄DLBCL的疗效及安全性影响

目的 探究联合利妥昔单抗的治疗方案对我国75 岁及以上老年弥漫大B 细胞淋巴瘤（DLBCL）患者的预后是否有改善。方法 回顾性分析2013 年1 月～2019 年5 月我院诊治的69 例75 岁及以上老年DLBCL 患者病例资料,根据治疗方式分为免疫化疗组和对症支持组,比较两组一般资料及总生存,多因素分析影响患者预后的相关因素。免疫化疗组根据2 疗程治疗后疾病是否进展分为未进展组和进展组,比较两组总生存情况。结果 全部患者中位随访时间为447 d,免疫化疗组2 个疗程后13 例患者完全缓解（27.1%）,17 例部分缓解（35.4%）,预计平均生存时间为1925.582 d,对症支持治疗组为122.985 d,差异有统计学意义（P=0.000）。多因素分析发现,仅治疗方式对OS 的影响有统计学意义（P=0.000）,仅对症支持治疗患者的死亡风险是免疫化疗患者的37.473 倍。免疫化疗组未出现治疗相关死亡,其未进展组和进展组3 年生存率比较（87.5% vs 50.0%）,差异有统计学意义（P=0.023）。结论 对于75 岁及以上老年弥漫大B 淋巴瘤患者,与仅对症支持治疗相比,联合利妥昔单抗的治疗可显著提高患者总生存率,且相对安全。对此类患者,治疗上不能一味追求疾病完全缓解,而是维持疾病不要进展对于患者预后有重要意义。

Effect of combined rituximab treatment on the efficacy and safety of elderly DLBCL

Objective To explore whether the treatment regimen with rituximab can improve the prognosis of diffuse large B-cell lymphoma(DLBCL) patients aged 75 years or above in China.Methods A total of 69 DLBCL patients aged 75 and over who were treated in our hospital from January 2013 to May 2019 were retrospectively analyzed.According to the treatment methods,they were divided into the immunochemotherapy group and the symptomatic support group.The general data and overall survival of the two groups were compared,and the related factors affecting the prognosis of the patients were analyzed by multivariate analysis.The immunochemotherapy group was divided into the non-progressive group and progressive group according to whether the disease progressed after two courses of treatment,and the overall survival of the two groups was compared.Results The median follow-up time of all patients was 447 days.After two immunochemotherapy courses,13 patients achieved a complete response (27.1%),and 17 patients achieved partial response(35.4%).The average estimated survival time was 1,925.582 days in the immunochemotherapy group,and 122.985 days in the symptomatic support group,with statistically significant differences(P=0.000).Multivariate analysis found that the effect of treatment alone on OS was statistically significant(P=0.000),and the risk of death in patients receiving symptomatic support therapy alone was 37.473 times higher than that in patients receiving immunochemotherapy.There was no treatment-related death in the immunochemotherapy group,and the difference in the 3-year survival rate between the non-progressive group and the progressive group was statistically significant(87.5% vs 50.0%,P=0.023).Conclusion In patients with diffuse large B lymphoma aged 75 years and older,rituximab combined with symptomatic support therapy significantly improves overall survival and is relatively safe.For such patients,treatment does not blindly pursue the complete remission of the disease,and maintaining the disease not to progress is of great significance to the patient''s prognosis.