(R)-CHOP方案中阿霉素平均每周剂量强度影响初诊弥漫大B细胞淋巴瘤患者的治疗效果

目的:CHOP方案是目前治疗弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)的标准方案?CD20单抗美罗华(rituximab,R)与CHOP方案联合后,R-CHOP方案的治疗效果进一步的提高?本研究着重分析治疗过程中药物的每疗程剂量?时间剂量强度等与治疗结果的关系?方法:回顾性研究经(R)-CHOP方案治疗的DLBCL初诊患者52例?分析国际预后指数(IPI)评分?CHOP方案中的强的松?环磷酰胺和阿霉素的平均每疗程剂量强度(DIPC)和平均每周剂量强度(DIPW)与疗效的关系?结果:病例的中位随诊时间为34个月(6~95个月),在经Pearson Chi-Square统计后发现,患者起病时的强的松DIPW<166.7 mg/m2?IPI评分?Ann Arbor分期(A或B)可以影响患者的完全缓解(CR)率(均P < 0.05)?在将上述与CR有关的因素进行Logistic回归分析后,发现强的松DIPW<166.7 mg/m2和IPI积分为与CR相关的独立预后因素(均P < 0.05)?对患者总生存(OS)资料进行Kaplan-Meier分析发现,经Log-rank检验后,IPI积分?阿霉素<16.7 mg/(m2?周)?环磷酰胺<250 mg/(m2?周)与DLBCL患者的OS有关?在将上述与OS有关的因素进行Cox regression分析后,发现阿霉素<16.7 mg/(m2?周)?IPI积分为与OS相关的独立预后因素(P均 < 0.05)?结论:对于用(R)-CHOP方案的初诊DLBCL患者,不但起病时的IPI积分?Ann Arbor分期(A或B)等与治疗结果相关,而且治疗因素如环磷酰胺和阿霉素的平均每周剂量强度也影响预后?在治疗过程中,应尽可能地按预定治疗方案给药?

Average weekly dose intensity of doxorubicin in (R)-CHOP regimen a prognostic factor for the overall survival in patients with diffuse large B-cell lymphoma

Objective:CHOP is the standard regimen to treat diffuse large B cell lymphoma (DLBCL). With the anti-CD20 monoclonal antibody (rituximab,R) combined with CHOP regimen,the therapeutic effect of R-CHOP regimen is further improved. To investigate the clinical significances of treatment-related variables for the diffuse large B-cell lymphoma (DLBCL) patients who treated with front-line (R)-CHOP regimen. Methods:This retrospective study evaluated 52 conservative newly diagnosed patients who were treated with (R)-CHOP regimen. The prognostic roles of international prognostic index (IPI),average dose intensity per cycle (DIPC) and dose intensity per week (DIPW) of cyclophosphamide,doxorubicin,prednisone in (R)-CHOP regimen were evaluated. Results:The median follow-up period of this study was 34 months(from 6 to 95 months). Pearson Chi-Square analysis showed that complete response (CR) rates were significantly affected by average DIPW of prednisone <166.7 mg/m2,IPI scores and Ann Arbor stage (A or B group) (all P < 0.05). When the two factors were subsequently tested by multifactorial Logistic stepwise regression,average DIPW of prednisone <166.7 mg/m2 and IPI scores were again showed to be independent risk factors for CR rate. With regards to OS,it was showed to be significantly affected by IPI scores,average DIPW of cyclophosphamide <250 mg/m2 and doxorubicin <16.7 mg/m2 (all P < 0.05). In the subsequent Cox regression test,only IPI scores and average DIPW of doxorubicin <16.7 mg/m2 were showed to be independent prognostic factor for OS rate. Conclusion:In addition to IPI scores and Anna Arbor stage (A or B group),average DIPW of doxorubicin was also showed to be an important prognostic factor for the clinical outcome of newly diagnosed DLBCL patients who were first-line treated with (R)-CHOP regimen. It is strongly recommended to strictly adhere to planned (R)-CHOP regimen schedule in every possibility.