Nastoupil Loretta J, Sinha Rajni, Byrtek Michelle, Ziemiecki Ryan, Taylor Michael, Friedberg Jonathan W, Koff Jean L, Link Brian K, Cerhan James R, Dawson Keith L, Flowers Christopher R
The University of Texas M. D. Anderson Cancer Center , Houston, TX , USA.
Leuk Lymphoma. 2015 May;56(5):1295-302. doi: 10.3109/10428194.2014.953144. Epub 2014 Nov 5.
To compare the effectiveness of frontline rituximab-chemotherapy regimens in clinical practice, we examined outcomes for patients with low-grade, stage III/IV follicular lymphoma receiving rituximab (R) with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), R with cyclophosphamide, vincristine and prednisone (R-CVP) or R with a fludarabine-based regimen (R-Flu) as frontline therapy. In total, 611 patients meeting these criteria were identified in the National LymphoCare Study: 47% receiving R-CHOP (n = 287), 31% receiving R-CVP (n = 187) and 22% receiving R-Flu (n = 137). Overall response rates were high (R-CVP 87%, R-CHOP 93%, R-Flu 94%; p = 0.017). Median follow-up was 7.4 years. R-CVP was associated with lower 5-year overall survival (R-CVP 76%, R-CHOP 86%, R-Flu 86%; p = 0.021) and progression-free survival (R-CVP 49%, R-CHOP 58%, R-Flu 64%; p = 0.029). There were no significant differences in survival in Cox models adjusted for baseline clinical factors, practice region/setting and post-treatment R maintenance/observation.
为比较一线利妥昔单抗化疗方案在临床实践中的有效性，我们研究了接受利妥昔单抗（R）联合环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）、R联合环磷酰胺、长春新碱和泼尼松（R-CVP）或R联合基于氟达拉滨的方案（R-Flu）作为一线治疗的低度、Ⅲ/Ⅳ期滤泡性淋巴瘤患者的结局。在国家淋巴瘤护理研究中，共确定了611例符合这些标准的患者：47%接受R-CHOP（n = 287），31%接受R-CVP（n = 187），22%接受R-Flu（n = 137）。总体缓解率较高（R-CVP 87%，R-CHOP 93%，R-Flu 94%；p = 0.017）。中位随访时间为7.4年。R-CVP与较低的5年总生存率（R-CVP 76%，R-CHOP 86%，R-Flu 86%；p = 0.021）和无进展生存率（R-CVP 49%，R-CHOP 58%，R-Flu 64%；p = 0.029）相关。在根据基线临床因素、实践地区/环境和治疗后R维持/观察进行调整的Cox模型中，生存率无显著差异。
