Yang Shen, Yu Yao, Jun-Min Li, Jian-Qing Mi, Qiu-Sheng Chen, Yu Chen, Wei-Li Zhao, Jian-Hua You, Hui-Jin Zhao, Yan Wang, Li Wang, Shu Cheng, Zhi-Xiang Shen
Department of Hematology, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiaotong University Medical School, Shanghai, China.
Ann Hematol. 2009 Sep;88(9):863-9. doi: 10.1007/s00277-009-0702-1. Epub 2009 Feb 10.
We performed this study to reassess the prognostic factors of diffuse large B-cell lymphoma (DLBCL) in the era of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Chinese population. One hundred and twenty-five consecutive patients with DLBCL were enrolled in this study from February 2000 to September 2006. They had received six courses of R-CHOP regimen consisting of rituximab 375 mg/m(2), intravenously, D1; cyclophosphamide 750 mg/m(2), bolus infusion, D2; doxorubicin 50 mg/m(2), bolus infusion, D2; vincristine 1.4 mg/m(2), bolus infusion, D2; and prednisone 60 mg, orally, D2-6. All the patients were evaluated and followed-up after the treatment. Eighty-six out of 125 enrolled patients (68.8%) achieved complete response (CR), 16 patients (12.8%) achieved partial response (PR), 11 patients (12.8%) achieved stable disease, and 12 patients (9.6%) experienced progressive disease (PD). In univariate analysis, IPI factors, except for age, was correlated with the treatment outcome of complete remission; however, only early clinical stages and absence of bulky disease was statistically significantly associated with the better CR rate. Lactate dehydrogenase (LDH), extranodal diseases, bulky disease, and obtaining CR after completion of four courses of treatment was correlated with TTF (P = 0.038, 0.044, 0.034, and 0.000, respectively); performance status, LDH level, number of extranodal diseases, and obtaining CR after completion four courses of treatment significantly influenced OS (P = 0.027, 0.000, 0.019, and 0.000, respectively); and presence of bulky disease and obtaining CR at the end of fourth cycle of treatment were significantly correlated with DFS in multivariate analysis (P = 0.006 and 0.001, respectively) in Cox regression. IPI is still important in predicting the prognosis in the R-CHOP era in DLBCL; however, obtaining CR after four cycles of R-CHOP and presence of bulky disease should be considered together.
我们开展这项研究，旨在重新评估在中国人群中，利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）时代弥漫性大B细胞淋巴瘤（DLBCL）的预后因素。2000年2月至2006年9月，连续纳入125例DLBCL患者。他们接受了6个疗程的R-CHOP方案治疗，具体为：利妥昔单抗375mg/m²，静脉滴注，第1天；环磷酰胺750mg/m²，静脉推注，第2天；多柔比星50mg/m²，静脉推注，第2天；长春新碱1.4mg/m²，静脉推注，第2天；泼尼松60mg，口服，第2 - 6天。所有患者在治疗后均接受评估和随访。125例纳入患者中，86例（68.8%）达到完全缓解（CR），16例（12.8%）达到部分缓解（PR），11例（12.8%）病情稳定，12例（9.6%）病情进展（PD）。单因素分析中，国际预后指数（IPI）因素（年龄除外）与完全缓解的治疗结局相关；然而，只有早期临床分期和无大包块病变与较好的CR率有统计学显著关联。乳酸脱氢酶（LDH）、结外病变、大包块病变以及完成4个疗程治疗后获得CR与无进展生存期（TTF）相关（P分别为0.038、0.044、0.034和0.000）；体能状态、LDH水平、结外病变数量以及完成4个疗程治疗后获得CR显著影响总生存期（OS）（P分别为0.027、0.000、0.019和0.000）；在多因素分析的Cox回归中，大包块病变的存在以及在第4周期治疗结束时获得CR与无病生存期（DFS）显著相关（P分别为0.006和0.001）。在DLBCL的R-CHOP时代，IPI在预测预后方面仍然很重要；然而，应综合考虑R-CHOP 4个周期后获得CR和大包块病变的存在情况。
