利妥昔单抗联合化疗治疗弥漫大B细胞淋巴瘤临床分析

 目的　观察利妥昔单抗（商品名：美罗华）联合化疗治疗弥漫大B细胞淋巴瘤（DLBCL）的临床疗效及淋巴瘤国际预后指数（IPI）评分对预后的影响；探讨利妥昔单抗在DLBCL自体外周血干细胞移植（APBSCT）中的应用。方法　DLBCL 患者21例，IPI评分低危和中低危（0～2分）14例，中高危和高危（3～5分）7例。采用利妥昔单抗联合CHOP（环磷酰胺、多柔比星、长春新碱、泼尼松）方案4～8个疗程，其中有5例接受APBSCT，动员方案为利妥昔单抗联合环磷酰胺加依托泊苷，预处理方案为CBV （环磷酰胺、卡莫司汀、依托泊苷）方案。结果　21例患者中CR 13例（61.9 %），总有效率90.5 %（19／21）；2年疾病无进展生存率为（69.74±10.43）%，2年总生存率为（84.44±8.35）%。IPI评分0～2分患者CR率92.9 %，总有效率100 %，3～5分患者CR率0，总有效率71.4 %，IPI 0～2分患者CR率高于3～5分患者（P＜0.01）；5例接受APBSCT的患者采集的中位单个核细胞（MNC）为7.34×108／kg，中位CD+34细胞为8.82×106／kg，造血恢复中性粒细胞＞0.5×109／L的中位时间＋9天，血小板＞20×109／L的中位时间＋12天；主要不良反应是输注相关的不良反应（14.3 %）以及化疗相关的血液学不良反应。结论　利妥昔单抗联合化疗治疗DLBCL疗效满意，IPI 0～2分患者的完全缓解率明显高于3～5分患者；利妥昔单抗不影响外周造血干细胞的采集及造血重建；利妥昔单抗应用安全性较好。

Clinical analysis of rituximab combined with chemotherapy for treatment of diffuse large B-cell lymphoma

Objectives To evaluate the efficacy of rituximab combined with chemotherapy in the treatment of diffuse large B-cell lymphoma (DLBCL) and the relationship of clinical prognosis with the International Prognostic Index (IPI) by the using rituximab in autologous peripheral stem cell transplantation (APBSCT) for the patients of DLBCL. Methods 21 patients with DLBCL, 11 patients of them were at IPI low risk, and 3 patients were IPI at low intermediate risk, 3 patients were at IPI high intermediate risk, 4patients IPI high risk. Rituximab combined with CHOP regimen (cyclophosphamide, adriamycin, vincfistine and prednisone) was given for 4～8 courses. 5 patients received APBSCT. The mobilizing regimen was rituximab combined with cyclophosphamide(CTX) and etoposide(VP16). The conditioning regimen were CBV(CTX combined with VP16 and carmustine). Results In 21 patients, the complete response rate was 61.9 %,with overall response rate 90.5 %. 2-year progression free survival was (69.74±10.43)%. 2-year overall survival was (84.44:1:8.35) %. The complete response rate was 92.9 % and overall response rate was 100 % in the patients IPI≤2. The overall response rate was 71.4 % in the patients with IPI≥3. The complete response rate was higher in the patients with IPI≤ 2 (P＜0.01). The amount of mononuclear cells (M NC) in harvest were 7.34 (4.6～8.53)×108/kg. The CD+34 cells in harvest were 8.82 (2.1～10.34)×1O6/kg. The mean time of neutrephil recovering to 0.5×109/L after APBSCT was +9 day. The mean time of platelet recovering to 20×109/L after APBSCT was +12 day. The major adverse reaction were infusion related response (14.3 %) and hematological toxieities. Conclusion The efficacy of rituximab combined with chemotherapy in the treatment of DLBCL is effective, The complete response rate was higher in the patients with IPI≤2 than in the patients with IPI≥3.Using rituximab in mobilizing regimen, all patients had harvested enough CD+34 cells. Rituximab given at +1day did not affect the hematopoiesis reconstruction.