美罗华联合CHOP方案与CHOP方案治疗侵袭性B细胞性淋巴瘤的临床对比研究

Comparison of Rituximab plus CHOP regimen and CHOP regimen alone for treatment of patients with aggressive B-cell lymphoma

关键词:  B细胞性淋巴瘤  美罗华  化疗

Key words:  B-cell non-Hodgkin’s lymphoma  Rituximab  chemotherapy

摘要:

［目的］ 比较美罗华联合CHOP方案和单用CHOP方案治疗侵袭性B细胞性淋巴瘤的疗效、生存和不良反应。［方法］ 采用同期非随机对照的方法，将40例侵袭性B细胞性淋巴瘤患者分为美罗华联合CHOP组（R-CHOP）和CHOP组。R-CHOP组19例，采用CHOP方案（环磷酰胺+阿霉素+长春新碱+强的松）加美罗华（375 mg/m²，于每周期化疗前1天静脉滴注1次）治疗；CHOP组21例，单用CHOP方案化疗。两组均每3周1个周期，6周期后比较两组的疗效及不良反应，并随访总生存及无病生存率。［结果］ 40例患者中，R-CHOP组19例患者共完成121周期化疗，平均5~8周期，中位周期数为6周期；CHOP组21例患者共完成135周期化疗，平均4~8周期，中位周期数为6周期。R-CHOP组完全缓解10例，部分缓解7例，总有效率为89.5%（17/19）；CHOP组完全缓解9例，部分缓解6例，总有效率为71.4%（15/21），两组疗效差异有显著性意义（P<0.05）；R-CHOP组和CHOP组1年总生存率为89.5%和71.4%，1年无进展生存率分别为78.9%和52.4%，R-CHOP组明显优于CHOP组（P<0.05）。两组患者的不良反应主要为轻中度骨髓抑制和胃肠道反应，不良反应发生率相近（P>0.05），两组均可耐受。［结论］美罗华联合CHOP方案能够提高CHOP方案治疗侵袭性B细胞性淋巴瘤的疗效，而毒性反应未见明显增加，可作为该病的一线治疗方案。

Abstract:

［Objective］ This work is to evaluate the efficacy, survival and toxicity of combination of chemotherapy consisting of Rituximab and CHOP in patients with aggressive B-cell non-Hodgkin's lymphomas. ［Methods］ Forty patients with histopathologically proven CD20-positive aggressive B-cell non-Hodgkin's lymphomas were assigned into R-CHOP group (19 patients) and CHOP group (21 patients). CHOP regimen consisted of Cyclophosphamide, Vincristine, Epirubicin and Prednisone. The cycle was repeated every 21 days. R-CHOP regimen was Rituximab 375mg/m² that was infused on the first day, and CHOP that followed on the second day. All of the patients received 6 chemotherapy cycles. The patients were followed up and the therapeutic effect was assessed. ［Results］ There were 10 CR and 7 PR in CHOP group and the overall response rate was 89.5% (17/19). There were 9 CR and 6 PR in R-CHOP group and the overall response rate was 71.4%(15/21). The response rate was significantly higher in the R-CHOP group than in the CHOP group(P<0.05). The one-year survival rates were 89.5% in R-CHOP group and 71.4% in CHOP group respectively. The one-year PFS rates were 78.9% and 52.4% respectively in the two groups, with a significant difference between them(P<0.05). The major side effects in the two groups were mild to moderate myelosuppression and gastrointestinal toxicity, without a significant difference between them(P>0.05). ［Conclusions］ Combined chemotherapy including Rituximab and CHOP (R-CHOP) is recommended as the preferred treatment for aggressive B-cell non-Hodgkin’s lymphoma because it is effect and well tolerated by the patients.