剂量调整 EPOCH-R 方案与 R-CHOP 方案在咽淋巴环弥漫大 B 细胞淋巴瘤一线治疗中的对比：来自单中心的回顾性研究。

Dose-adjusted EPOCH-R vs. R-CHOP in frontline management of Waldeyer's ring diffuse large B-cell lymphoma: a retrospective study from a single institution.

机构信息

Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.

Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.

出版信息

Chin Med J (Engl). 2023 Jan 20;136(2):167-175. doi: 10.1097/CM9.0000000000002593.

DOI:10.1097/CM9.0000000000002593

PMID:36780421

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10106141/

Abstract

BACKGROUND

To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Waldeyer's ring diffuse large B-cell lymphoma (WR-DLBCL) at a single institution.

METHODS

This retrospective study included 115 newly diagnosed patients with WR-DLBCL, of whom 68 patients received R-CHOP, and 47 patients received DA-EPOCH-R as their first-line treatment. The baseline features of the two groups were well balanced using a 1:1 propensity score matching method, and a total of 84 cases were obtained, including respective 42 cases in the R-CHOP and DA-EPOCH-R groups, for further survival and prognosis analysis. The primary objectives included progression-free survival (PFS) and overall survival (OS).

RESULTS

During a median follow-up of 45 months, there were nine (21.4%) deaths in the R-CHOP group and two (4.8%) in the DA-EPOCH-R group. Kaplan-Meier analysis showed statistically significant improvements in PFS and OS in patients with DA-EPOCH-R compared with those treated with R-CHOP (log-rank test, P = 0.025 and P = 0.035, respectively). The 2-year PFS and OS rates in the DA-EPOCH-R group were 90.1% (95% confidence interval [CI]: 81.4-99.8%) and 95.2% (95% CI: 89.0-100.0%), respectively, and 80.5% (95% CI: 69.3-93.6%) and 90.5% (95% CI: 52.8-99.8%) in the R-CHOP group. Patients without B symptoms and elevated lactate dehydrogenase levels had a higher PFS in the DA-EPOCH-R group, with P values of 0.038 (hazard ratio [HR]: 0.11; 95% CI: 0.01-0.88) and 0.042 (HR: 0.19; 95% CI: 0.04-0.94), respectively. There were no statistically significant differences in clinical responses and treatment-related toxicities between the two groups.

CONCLUSION

Compared with patients received R-CHOP, those treated by DA-EPOCH-R had superior PFS, OS, and controlled toxicity in patients with WR-DLBCL.

摘要

背景

本研究旨在比较剂量调整依托泊苷、泼尼松、长春新碱、环磷酰胺和多柔比星联合利妥昔单抗（DA-EPOCH-R）与标准利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）在单一机构中治疗咽淋巴环弥漫性大 B 细胞淋巴瘤（WR-DLBCL）的疗效和安全性。

方法

这是一项回顾性研究，纳入了 115 例新诊断的 WR-DLBCL 患者，其中 68 例患者接受 R-CHOP 治疗，47 例患者接受 DA-EPOCH-R 作为一线治疗。采用 1:1 倾向评分匹配方法对两组的基线特征进行均衡比较，共获得 84 例患者，其中 R-CHOP 组和 DA-EPOCH-R 组分别为 42 例，用于进一步的生存和预后分析。主要研究终点包括无进展生存期（PFS）和总生存期（OS）。

结果

在中位随访 45 个月时，R-CHOP 组有 9 例（21.4%）死亡，DA-EPOCH-R 组有 2 例（4.8%）死亡。Kaplan-Meier 分析显示，与 R-CHOP 治疗组相比，DA-EPOCH-R 治疗组的 PFS 和 OS 显著改善（对数秩检验，P=0.025 和 P=0.035）。DA-EPOCH-R 组的 2 年 PFS 和 OS 率分别为 90.1%（95%CI：81.4-99.8%）和 95.2%（95%CI：89.0-100.0%），R-CHOP 组分别为 80.5%（95%CI：69.3-93.6%）和 90.5%（95%CI：52.8-99.8%）。无 B 症状和乳酸脱氢酶水平升高的患者在 DA-EPOCH-R 组的 PFS 更高，P 值分别为 0.038（风险比 [HR]：0.11；95%CI：0.01-0.88）和 0.042（HR：0.19；95%CI：0.04-0.94）。两组间临床反应和治疗相关毒性无统计学差异。