利妥昔单抗联合CHOP方案治疗骨原发性非何杰金淋巴瘤的疗效和预后分析

目的骨的原发性淋巴瘤虽然可以通过化疗和放疗得到有效控制，但复发的比率很高。本研究旨在分析和评价利妥昔单抗联合CHOP方案治疗CD20阳性骨原发性非何杰金淋巴瘤的临床疗效及其安全性。方法回顾11例利妥昔单抗联合CHOP方案治疗的骨原发性非何杰金淋巴瘤患者临床资料，利妥昔单抗用药方法为375mg／m^2，于每周期化疗前1d静脉滴注，每3周为1个循环周期；6～8个周期后评价疗效及不良反应，同时与单纯应用CHOP化疗的患者进行回顾性疗效分析比较。结果11例患者接受利妥昔单抗联合CHOP方案化疗，完全缓解（CR）8例，部分缓解（PR）3例。随诊时间9—65个月，8例无瘤生存，1例转化为淋巴细胞型白血病，患者带瘤生存，2例死亡，患者生存率81．8％（9／11），无病生存率72．7％（8／11）；Kaplan—Meier生存曲线计算应用利妥昔单抗的患者5年预期整体生存率（overall survival，OS）为60．6％。R—CHOP化疗后最常见的复发部位为中枢神经系统。不良反应与单纯应用CHOP化疗组无显著差异，主要为过敏和发热，以及化疗相关的血液学毒性，未出现爆发性肝衰竭。结论利妥昔单抗联合CHOP方案治疗骨原发性非何杰金淋巴瘤（CD20^＋）效果显著，如何降低中枢神经系统复发是今后的研究方向。

The efficacy and prognosis analysis of rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisone regimen in the treatment of primary non-Hodgkin lymphoma of bone

Objective The treatment of primary lymphoma of bone （PLB） by chemotherapy and radiotherapy is efficient in terms of tumor response. However, the recurrence rate is very high. This paper aims to analyze and evaluate the efficacy and safety of rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisone （CHOP） regimen in the treatment of CD20 positive primary non-Hodgkin lymphoma of bone. Methods The clinical data of 11 patients with primary non-Hodgkin lymphoma of bone treated by rituximab in combination with CHOP regimen were analyzed respectively. 375mg/m^2 rituximab was given by intravenous drip 1 day before chemotherapy each period （3 weeks）. After 6 to 8 periods, the efficiency and side effects were evaluated, and meanwhile the efficiency of the control group treated by CHOP chemotherapy alone was analyzed and compared retrospectively. Results Among the 11 patients treated by rituximab in combination with CHOP chemotherapy, 8 patients achieved complete response （CR）, and 3 patients achieved partial response （PR）. The follow-up period ranged from 9 to 65 months. 8 patients survived without any tumor, 1 patient had lymphoblastic leukemia instead, living with tumors, and 2 patients died. The survival rate of the patients was 81.8% （9/11）, and the disease free survival rate was 72.7% （8/11）. According to the Kaplan-Meier survival curse, the overall survival （OS） rate of the patients treated by rituximab was expected to be 60.6% in 5 years. The most common site of recurrence after rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone （R-CHOP） chemotherapy was the central nervous system. The side effects were mainly allergy, fever and hematological toxicity relating to chemotherapy, and without fulminant hepatic failure, which were not significantly different from that of the control group. Conclusions The efficacy of rituximab in combination with CHOP regimen in the treatment of primary non-Hodgkin lymphoma of bone （CD20^＋） is remarkable, and how to reduce the recurrence rate in the central nervous system deserves further investigation.