Ma Qianwen, Chang Yu, Li Ling, Li Xin, Wang Xinhua, Wu Jingjing, Fu Xiaorui, Sun Zhenchang, Yu Hui, Zhang Xudong, Zhou Zhiyuan, Nan Feifei, Li Zhaoming, Liu Xiyang, Zhao Qian, Li Yang, Zhang Lan, Zhang Mingzhi, Zhang Lei
Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan, China,
Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou 450000, Henan, China,
Cancer Manag Res. 2019 Feb 11;11:1363-1372. doi: 10.2147/CMAR.S192143. eCollection 2019.
To compare the efficacy of rituximab, dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-DA-EPOCH) with traditional rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimens in double-hit lymphoma (DHL) and gene copy number gain (CNG) lymphoma and to contrast the prognosis of these two disease types.
We retrospectively examined 127 cases of newly diagnosed diffuse large B-cell lymphoma (DLBCL), and used fluorescence in situ hybridization (FISH) to detect genetic abnormalities in and .
In the two schemes, the 2-year progression-free survival (PFS) was higher for R-DA-EPOCH group than for R-CHOP (79.8% vs 57.5%, =0.002), this advantage was also reflected in 2-year overall survival (OS) (81.6% vs 58.5%, =0.002). In double CNG patients, R-DA-EPOCH regimen was significantly better than R-CHOP (=0.007 for PFS, =0.010 for OS), and R-DA-EPOCH has the same advantage in DHL patients (=0.001 for PFS, =0.047 for OS). For the two disease types, the PFS for DHL was inferior to that for double CNG (52.9% vs 72.4%, =0.008), while the OS was not significantly different (=0.050). Subgroup analysis showed that the PFS for double CNG with and was superior to that for DHL with and (=0.043), this trend is also seen in double CNG and DHL with and (=0.036). However, the OS was not significantly different between the two subgroups. Multivariate analyses showed that in DLBCL patients with genetic abnormality detected by FISH, the treatment and disease types were independent prognostic factors. The adverse reaction rates were similar in R-DA-EPOCH and R-CHOP (>0.05).
Our retrospective study shows that DHL has a poorer prognosis than double CNG. Based on its improved lifetime and good tolerance, R-DA-EPOCH is a promising regimen for DHL or double CNG, which is expected to become the first-line treatment for high-risk DLBCL types based on more clinical research.
比较利妥昔单抗、剂量调整的依托泊苷、泼尼松、长春新碱、环磷酰胺和多柔比星（R-DA-EPOCH）方案与传统的利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）方案在双打击淋巴瘤（DHL）和基因拷贝数增加（CNG）淋巴瘤中的疗效，并对比这两种疾病类型的预后。
我们回顾性研究了127例新诊断的弥漫性大B细胞淋巴瘤（DLBCL）患者，并使用荧光原位杂交（FISH）检测[具体基因]和[具体基因]的基因异常情况。
在这两种方案中，R-DA-EPOCH组的2年无进展生存期（PFS）高于R-CHOP组（79.8%对57.5%，P = 0.002），这一优势在2年总生存期（OS）中也有体现（81.6%对58.5%，P = 0.002）。在双CNG患者中，R-DA-EPOCH方案显著优于R-CHOP方案（PFS的P = 0.007，OS的P = 0.010），且R-DA-EPOCH方案在DHL患者中也有同样优势（PFS的P = 0.001，OS的P = 0.047）。对于这两种疾病类型，DHL的PFS低于双CNG（52.9%对72.4%，P = 0.008），而OS无显著差异（P = 0.050）。亚组分析显示，伴有[具体基因]和[具体基因]的双CNG的PFS优于伴有[具体基因]和[具体基因]的DHL（P = 0.043），在伴有[具体基因]和[具体基因]的双CNG和DHL中也可见此趋势（P = 0.036）。然而，两个亚组之间的OS无显著差异。多因素分析显示，在FISH检测到基因异常的DLBCL患者中，治疗方案和疾病类型是独立的预后因素。R-DA-EPOCH和R-CHOP的不良反应发生率相似（P>0.05）。
我们的回顾性研究表明，DHL的预后比双CNG差。基于其改善的生存期和良好的耐受性，R-DA-EPOCH是DHL或双CNG的一种有前景的方案，有望基于更多临床研究成为高危DLBCL类型的一线治疗方案。
