CAJ | 학술논문

目的重新评估R-CHOP(利妥昔单抗、环磷酰胺、阿霉素、长春新碱、泼尼松)方案治疗弥漫大B细胞淋巴瘤(DLBCL)的预后因素.方法 2000年2月至2006年9月125例初治DLBCL患嗜接受6个疗程的R-CHOP[利妥昔单抗375 mg/m2,缓慢静脉滴注,第1 d;环磷酰胺750 mg/m2,静脉推注,第2 d,阿霉素50 mg/m2,静脉推注,第2 d;长春新碱1.4 mg/m2(最大剂量2.0 mg),静脉推注,第2 d,泼尼松60 mg,口服,第2～6 d]治疗后,对患者进行治疗反应的评估和随访.结果在入选的125例患者中,86例(68.8%)获得完全缓解(CR),16例(12.8%)获得部分缓解(PR),总反应率为81.6%,11例患者(8.8%)获得疾病稳定(SD),12例患者(9.6%)疾病进展.在单因素分析中,ECOG分级、临床分期、LDH水平、结外病变、国际预后指数(IPI)积分和巨块病变的有无均与CR有关;在多因素分析中,仅ECOG评分、临床分期和巨块病变对获得CR的差异有统计学意义(P值分别为0.0098、0.0000和0.0040).患者24个月的治疗至失败时间(TTF)、总生存(OS)率和无病生存(DFS)率分别为(59.7±5.3)%、(67.1±5.6)%和(77.6±5.8)%.在单因素分析中,年龄和结外病变对TTF、OS和DFS率均无显著影响.而其余IPI因素,包括LDH、临床分期和行为状态对OS率和TTF均有显著影响,而对DFS率无明显影响.在多因素分析中,是否获得CR是影响TTF唯一的预后因素(P=0.001),它同时影响OS率(P=0.001).其他影响OS率的指标包括LDH水平和ECOG评分(P值分别为0.002和0.009).巨块病变是影响DFS率的唯一重要因素(P=0.007).结论 R-CHOP方案治疗中,IPI预后积分的预后意义具有一定局限性.6个疗程治疗后获得CR和巨块病变可能是IPI外另两个非常重要的临床预后因素.
목적 중신평고R-CHOP(리타석단항、배린선알、아매소、장춘신감、발니송)방안치료미만대B세포림파류(DLBCL)적예후인소.방법 2000년2월지2006년9월125례초치DLBCL환기접수6개료정적R-CHOP[리타석단항375 mg/m2,완만정맥적주,제1 d;배린선알750 mg/m2,정맥추주,제2 d,아매소50 mg/m2,정맥추주,제2 d;장춘신감1.4 mg/m2(최대제량2.0 mg),정맥추주,제2 d,발니송60 mg,구복,제2～6 d]치료후,대환자진행치료반응적평고화수방.결과 재입선적125례환자중,86례(68.8%)획득완전완해(CR),16례(12.8%)획득부분완해(PR),총반응솔위81.6%,11례환자(8.8%)획득질병은정(SD),12례환자(9.6%)질병진전.재단인소분석중,ECOG분급、림상분기、LDH수평、결외병변、국제예후지수(IPI)적분화거괴병변적유무균여CR유관;재다인소분석중,부ECOG평분、림상분기화거괴병변대획득CR적차이유통계학의의(P치분별위0.0098、0.0000화0.0040).환자24개월적치료지실패시간(TTF)、총생존(OS)솔화무병생존(DFS)솔분별위(59.7±5.3)%、(67.1±5.6)%화(77.6±5.8)%.재단인소분석중,년령화결외병변대TTF、OS화DFS솔균무현저영향.이기여IPI인소,포괄LDH、림상분기화행위상태대OS솔화TTF균유현저영향,이대DFS솔무명현영향.재다인소분석중,시부획득CR시영향TTF유일적예후인소(P=0.001),타동시영향OS솔(P=0.001).기타영향OS솔적지표포괄LDH수평화ECOG평분(P치분별위0.002화0.009).거괴병변시영향DFS솔적유일중요인소(P=0.007).결론 R-CHOP방안치료중,IPI예후적분적예후의의구유일정국한성.6개료정치료후획득CR화거괴병변가능시IPI외령량개비상중요적림상예후인소.
Objective To reassess the prognostic factors of diffuse large B cell lymphoma(DLBCL)treated with R-CHOP therapy.Methods One hundred and twenty five patients were enrolled in this study from Feb.2000 to Sep.2006.They received 6 courses of R-CHOP regimen consisting of rituximab 375 mg/m2,intravenously,d 1;cyclophosphamide 750 mg/m2,bolus intravenously,d 2;doxorubicin 50 mg/m2,bolus intravenously,d 2;vincristine 1.4 mg/m2,bolus intravenously,d 2 and prednisone 60 mg,orally,d 2～6. All the patients were evaluated and followed up after the treatment.Results Eighty six patients(68.8%)achieved complete response(CR),16(12.8%)partial response(PR),11(12.8%)stable disease(SD)and 12(9.6%)progressive disease(PD).In univariate analysis,performance status(PS),clinical stage,LDH level,extranodal disease,international prognostic index(IPI)and bulky disease were statistically significantly correlated with the induction of CR;however,only PS,clinical stage and bulky disease remained significant in multi-variate analysis(P=0.0098,0.000 and 0.004,respectively).Twenty four month for time to treatment failure(TTF)rate,overall survival(OS)rate,and disease free survival(DFS)rate was(59.7±5.3)%,(67.1±5.6)%and(77.6±5.8)%,respectively.In univariate analysis,LDH,clinical stage and PS exerted significant effect on TTF and OS rate,but not on DFS rate;age and extranodal disease was not related with TTF,OS and DFS rate.In multi-variate analysis,achieved CR was the Only prognostic factor for TTF(P=0.001)and bulky disease had influence on DFS rate.LDH level,PS,and achieved CR was correlated with the OS rate in multi-variate setting(P=0.002,0.009 and 0.001 respectiVely). Conclusion IPI score has its limitation in predicting the prognosis in the R-CHOP era in DLBCL. Other two relevant prognostic factors are bulky disease and achieved CR after 6 courses of treatment.