吉西他滨联合洛铂和地塞米松治疗非生发中心型弥漫大B细胞淋巴瘤的近期疗效观察

目的:探讨GDL(吉西他滨、地塞米松、洛铂)与R -GDL、R-CHOP和CHOP治疗非生发中心型弥漫大B细胞淋巴瘤的近期疗效以及最佳治疗方案.方法:对确诊的非生发中心型弥漫大B细胞淋巴瘤109例患者,24例应用R-GDL方案治疗,28例应用GDL方案,25例应用R-CHOP方案,32例应用CHOP方案.前瞻性的随机对照比较R-GDL、GDL、R-CHOP和CHOP方案治疗患者的近期疗效,并评估治疗安全性.结果:R-GDL组完全缓解(CR) 15例,部分缓解(PR)6例,总有效率为87.5％ (21/24)；GDL组CR 8例,PR 7例,总有效率为53.6％(15/28),R-CHOP组总有效率为64.0％(16/25),CHOP组43.8％(14/32).其中GDL组显著优于CHOP组,P=0.04;加用美罗华组较单纯化疗组差异有统计学意义,P值分别为0.006、0.045.GDL组1年的无进展生存率(57.1％)显著优于CHOP组(46.9％),P=0.04;含美罗华组显著优于单纯化疗组,P值分别为0.034、0.002.含洛铂的方案血小板下降明显,需预防性应用升血小板的药物,其肝肾心脏毒性较小,加或不加美罗华不良反应率无明显改变.结论:吉西他滨联合洛铂、地塞米松方案有效率比R-GDL、R-CHOP和CHOP方案治疗非生发中心型弥漫大B细胞淋巴瘤略高,但骨髓抑制较重,在化疗的基础上增加美罗华能进一步提高疗效.

Short-term efficacy of gemcitabine combined with lobaplatin and dexamethasone regimen on non-germinal center B-cell diffuse large B cell lymphoma

OBJECTIVE:This study was to compare the short-term efficacy of(R)-GDL,GDL,R-CHOP and CHOP regimens on Non-Germinal center B-cell diffuse large B cell lymphoma(non-GCB DLBCL) patients.To explore the optimal regimen for initial treatment.METHODS:A total 109 patients of non-GCB DLBCL were enrolled.According to different treatment regimens,the patients divided in four groups,including 24 patients by R-GDL,28 patients by GDL,25 patients by R-CHOP and 32 patients by CHOP.Efficacy assessment was conducted after two cycles therapy with followed up the side effects.RESULTS:The total response rate in R-GDL group was 87.5%(21/24),among which complete responses(CR) was in 15 patients and partial responses(PR) in 6 patients:The total response rate in GDL group was 53.6%(15/28) among which CR was in 8 patients and PR was in 7 patients.The total response rate in R-CHOP and CHOP groups were 64.0%(16/25),43.8%(14/32).The therapeutic efficacy was significantly better in GDL group than in CHOP group(P<0.05),and combination group was better than GDL and CHOP group(P=0.006,P=0.045).The 1-year progression-freely survival rates were significantly higher in GDL group than that in CHOP group(P=0.04),combination group was higher than that in GDL and CHOP groups(P=0.034,P=0.002).The major adverse events in GDL group were hematological toxicities and nausea/vomit and other adverse events were rare.The adverse events in combination groups were similar to simple chemotherapy groups.CONCLUSIONS:GDL regimen increases the therapeuticefficacy on newly diagnosed patients with non-Germinal center B-cell diffuse large B cell lymphoma,but the thrombocytopenia was severer than CHOP groups.The use of rituximab can increase efficacy.