Rueda Antonio, Sabin Pilar, Rifá Juli, Llanos Marta, Gómez-Codina José, Lobo Francisco, García Ramón, Herrero Joaquin, Provencio Mariano, Jara Carlos
Medical Oncology Service, Hospital Clínico Universitario, Málaga, Spain.
Hematol Oncol. 2008 Mar;26(1):27-32. doi: 10.1002/hon.829.
Several studies have shown that adding rituximab to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) or reducing the interval between chemotherapy cycles from 3 weeks to 2 weeks improves survival in patients with diffuse large B-cell lymphoma (DLBCL). These studies prompted our group (GOTEL) to evaluate prospectively in a pilot study the feasibility and efficacy of R-CHOP-14 in patients with DLBCL. Patients (<70 years) with stage II bulky or stage III or IV DLBCL and no significant comorbidities were included in the study. Rituximab was administered on day 1 before chemotherapy. R-CHOP was given every 14 days. All patients received filgrastim (5 microg/kg) from days 4 to 10. From May 2002 to August 2004, 80 patients were recruited. Median age was 53 years and 58 patients were <60 years. According to the age-adjusted international prognostic index (aaIPI), 13 patients (16%) had low-risk disease, 31 (39%) low-to-intermediate risk, 27 (34%) high-to-intermediate risk and 9 (11%) high-risk disease. Grade 3-4 neutropenia was observed in 15 patients (17.5%) and grade 3-4 infections in 13 patients (16%). After therapy, 58 patients (73%) achieved CR-CRu (95% CI: 55-90%). With a median follow-up of 26 months, progression-free survival (PFS) and overall survival (OS) at 30 months were 72% and 86%, respectively. Administration of R-CHOP-14 is feasible and effective in patients <70 years.
多项研究表明，在CHOP（环磷酰胺、阿霉素、长春新碱、泼尼松龙）方案中加入利妥昔单抗，或将化疗周期的间隔时间从3周缩短至2周，可提高弥漫性大B细胞淋巴瘤（DLBCL）患者的生存率。这些研究促使我们团队（GOTEL）在一项前瞻性试点研究中评估R-CHOP-14方案对DLBCL患者的可行性和疗效。研究纳入了年龄小于70岁、患有II期大包块型或III期或IV期DLBCL且无明显合并症的患者。在化疗前第1天给予利妥昔单抗。每14天进行一次R-CHOP方案化疗。所有患者在第4至10天接受非格司亭（5微克/千克）治疗。从2002年5月至2004年8月，共招募了80例患者。中位年龄为53岁，58例患者年龄小于60岁。根据年龄调整后的国际预后指数（aaIPI），13例患者（16%）为低危疾病，31例（39%）为低至中危，27例（34%）为高至中危，9例（11%）为高危疾病。15例患者（17.5%）出现3-4级中性粒细胞减少，13例患者（16%）出现3-4级感染。治疗后，58例患者（73%）达到完全缓解-未复发（CR-CRu，95%置信区间：55-90%）。中位随访26个月，30个月时的无进展生存期（PFS）和总生存期（OS）分别为72%和86%。对于年龄小于70岁的患者，给予R-CHOP-14方案是可行且有效的。
