Rohlfing Sarah, Aurich Matthias, Schöning Tilman, Ho Anthony D, Witzens-Harig Mathias
Department of Hematology and Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
Department of Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
Clin Lymphoma Myeloma Leuk. 2015 Aug;15(8):458-63. doi: 10.1016/j.clml.2015.03.008. Epub 2015 Mar 24.
The aim of this retrospective analysis was to investigate the efficacy and safety of nonpegylated liposomal doxorubicin (NPLD) as part of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) in patients with diffuse large B-cell lymphoma (DLBCL) and preexisting cardiac diseases.
Twenty-five patients were evaluated, median age was 73 (range 24-85) years, 23 patients received NPLD as part of their first-line therapy. Most patients suffered from more than 1 cardiac disease and in 14 patients left ventricular ejection fraction (LVEF) was reduced. One hundred nineteen cycles of NPLD were applied with a median of 5 (range 2-8) cycles per patient. Median dose per cycle was 95 mg (50 mg/m(2)).
The overall response rate was 96% (44% complete remission, 52% partial remission). After a median follow-up of 23 months, 4 patients had disease relapse. Seven patients died, translating to an estimated 3-year progression-free and overall survival of 66% and 73%, respectively. Reasons for death were progressive disease or infection in 2 patients each and cardiovascular disease in 3 patients. After chemotherapy, LVEF decreased significantly in 28% and improved in 12% of patients, whereas median LVEF did not change (51% vs. 50%). No higher frequencies of decreased LVEF was observed in the group of patients with preexisting reduced LVEF. Five adverse events induced therapy termination: 2 myocardial infarctions, 2 pneumonias, and 1 reduced condition. No hand-foot-syndrome was observed.
NPLD as a component of R-CHOP is an effective treatment in patients with DLBCL and preexisting cardiac diseases, whereas cardiac events were observed in 36% of patients in this cardiac high-risk group. However, these results need to be confirmed in a prospective randomized trial.
本回顾性分析的目的是研究非聚乙二醇化脂质体阿霉素（NPLD）作为R-CHOP（利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松）方案的一部分，用于治疗弥漫性大B细胞淋巴瘤（DLBCL）合并原有心脏病患者的疗效和安全性。
对25例患者进行了评估，中位年龄为73岁（范围24-85岁），23例患者接受NPLD作为一线治疗方案的一部分。大多数患者患有不止一种心脏病，14例患者左心室射血分数（LVEF）降低。共应用了119个周期的NPLD，每位患者的中位周期数为5个（范围2-8个）。每个周期的中位剂量为95毫克（50毫克/平方米）。
总缓解率为96%（44%完全缓解，52%部分缓解）。中位随访23个月后，4例患者疾病复发。7例患者死亡，估计3年无进展生存率和总生存率分别为66%和73%。死亡原因分别为2例患者疾病进展或感染，3例患者心血管疾病。化疗后，28%的患者LVEF显著下降，12%的患者LVEF改善，而中位LVEF未发生变化（51%对50%）。在原有LVEF降低的患者组中，未观察到LVEF下降频率更高的情况。5例不良事件导致治疗终止：2例心肌梗死、2例肺炎和1例病情恶化。未观察到手足综合征。
NPLD作为R-CHOP方案的一个组成部分，对于DLBCL合并原有心脏病的患者是一种有效的治疗方法，然而，在这个心脏高危组中，36%的患者发生了心脏事件。不过，这些结果需要在前瞻性随机试验中得到证实。
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