利妥昔单抗联合强化治疗对伴骨髓侵犯的滤泡性淋巴瘤患者的疗效分析
리타석단항연합강화치료대반골수침범적려포성림파류환자적료효분석
Curative effect analysis of rituximab combined with intensive chemotherapy for follicular lymphoma patients with bone marrow involvement
  • 万方数据
    中华医学杂志 중화의학잡지
    National Medical Journal of China
    2015年 44期 3593-3597 ,共5页

    熊文婕%易树华%李姮%刘慧敏%李增军%吕瑞%刘薇%邹德慧%邱录贵

    웅문첩%역수화%리항%류혜민%리증군%려서%류미%추덕혜%구록귀

    淋巴瘤,滤泡型%药物疗法,联合%骨髓侵犯%利妥昔单抗 淋巴瘤,濾泡型%藥物療法,聯閤%骨髓侵犯%利妥昔單抗
    림파류,려포형%약물요법,연합%골수침범%리타석단항
    Lymphoma,follicular%Drug therapy,combination%Bone marrow involvement%Rituximab
    目的 探讨不同治疗方案对伴有骨髓侵犯的初治滤泡性淋巴瘤(FL)患者的疗效.方法 回顾性分析2002年1月至2013年12月就诊于中国医学科学院血液学研究所的38例初治伴骨髓侵犯的FL患者的临床特征,比较不同治疗方案的疗效及生存情况.结果 所有患者中位发病年龄43岁(19 ～ 74岁),滤泡性淋巴瘤国际预后指数(FLIPI)评分低、中、高危组分别为11例(28.9%)、11例(28.9%)和16例(42.1%).36例接受联合化疗患者的总反应率(ORR)为100%,完全缓解率(CR)为66.7%,部分缓解率(PR)为33.3%.36例接受联合化疗的患者中,使用利妥昔单抗治疗患者31例(86.1%),使用利妥昔单抗联合化疗的患者3年总生存(OS)率明显高于未使用利妥昔单抗患者(94.4%比80.0%,P=0.012),3年无进展生存(PFS)率二者差异无统计学意义(P=0.305).在31例使用利妥昔单抗联合化疗的患者中,16例患者采用RCHOP样方案(利妥昔单抗联合环磷酰胺、表柔比星、长春新碱及泼尼松)、9例为RFC样方案(利妥昔单抗联合氟达拉滨及环磷酰胺),6例高侵袭性表现的年轻高肿瘤负荷患者使用R-HyperCVAD样方案(利妥昔单抗联合环磷酰胺、长春新碱、表柔比星及地塞米松).RFC及R-HyperCVAD样强化治疗方案与RCHOP样方案相比,患者3年PFS率明显升高(92.3%比48.9%,P=0.036),3年OS率差异无统计学意义(P=0.190).RFC样方案治疗患者3年PFS率明显高于RCHOP样方案治疗患者(100%比48.9%,P=0.029),而3年OS率二者间差异亦无统计学意义(100%比85.7%,P=0.285).在36例使用联合化疗的患者中,13例患者使用利妥昔单抗维持治疗,其3年PFS率(92.3%比58.7%,P=0.025)和OS率(100%比80.0%,P=0.040)均明显高于未采用维持治疗患者.结论 伴有骨髓侵犯的FL患者发病年龄较年轻,FLIPI中、高危患者比例较高.利妥昔单抗联合强化方案治疗可提高这部分患者疗效,利妥昔单抗维持治疗可进一步使这部分患者生存获益.
    목적 탐토불동치료방안대반유골수침범적초치려포성림파류(FL)환자적료효.방법 회고성분석2002년1월지2013년12월취진우중국의학과학원혈액학연구소적38례초치반골수침범적FL환자적림상특정,비교불동치료방안적료효급생존정황.결과 소유환자중위발병년령43세(19 ～ 74세),려포성림파류국제예후지수(FLIPI)평분저、중、고위조분별위11례(28.9%)、11례(28.9%)화16례(42.1%).36례접수연합화료환자적총반응솔(ORR)위100%,완전완해솔(CR)위66.7%,부분완해솔(PR)위33.3%.36례접수연합화료적환자중,사용리타석단항치료환자31례(86.1%),사용리타석단항연합화료적환자3년총생존(OS)솔명현고우미사용리타석단항환자(94.4%비80.0%,P=0.012),3년무진전생존(PFS)솔이자차이무통계학의의(P=0.305).재31례사용리타석단항연합화료적환자중,16례환자채용RCHOP양방안(리타석단항연합배린선알、표유비성、장춘신감급발니송)、9례위RFC양방안(리타석단항연합불체랍빈급배린선알),6례고침습성표현적년경고종류부하환자사용R-HyperCVAD양방안(리타석단항연합배린선알、장춘신감、표유비성급지새미송).RFC급R-HyperCVAD양강화치료방안여RCHOP양방안상비,환자3년PFS솔명현승고(92.3%비48.9%,P=0.036),3년OS솔차이무통계학의의(P=0.190).RFC양방안치료환자3년PFS솔명현고우RCHOP양방안치료환자(100%비48.9%,P=0.029),이3년OS솔이자간차이역무통계학의의(100%비85.7%,P=0.285).재36례사용연합화료적환자중,13례환자사용리타석단항유지치료,기3년PFS솔(92.3%비58.7%,P=0.025)화OS솔(100%비80.0%,P=0.040)균명현고우미채용유지치료환자.결론 반유골수침범적FL환자발병년령교년경,FLIPI중、고위환자비례교고.리타석단항연합강화방안치료가제고저부분환자료효,리타석단항유지치료가진일보사저부분환자생존획익.
    Objective To investigate the efficacy of different regimens in previously untreated follicular lymphoma (FL) patients with bone marrow involvement.Methods Clinical data of 38 previously untreated FL patients with bone marrow involvement visited Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences during the period from January 2002 to December 2013 were analyzed retrospectively, in order to compare the efficacy and survival status of different regimens.Results The median age of onset was 43 years (19-74 years).The number of patients in low, intermediate and high risk group according to the follicular lymphoma international prognostic index (FLIPI) was 11 (28.9%), 11 (28.9%), and 16 (42.1%) respectively.And 36 of the 38 patients received combined chemotherapies.The overall response rate (ORR), complete remission (CR) rate, and partial remission (PR) rate were 100% , 66.7%, and 33.3% , respectively.A total of 31 patients (86.1%) used rituximab, in whom the 3-year overall survival (OS) was significantly higher than that in those who had not used rituximab (94.4% vs 80.0%, P =0.012) , but the difference between 3-year progression-free survival (PFS) rate had no statistical significance (P =0.305).In the rituximab group, 16 patients had received RCHOP (rituximab, cyclophosphamide, epirubicin, vincristine, prednisone), 9 patients had received RFC (rituximab, fludarabine, cyclophosphamide), 6 young patients with high invasion and high tumor burden had received R-HyperCVAD (rituximab , cyclophosphamide, epirubicin, vincristine, dexamethasone).In the RFC/R-HyperCVAD group, the 3-year PFS was significantly higher than that in the RCHOP group (92.3% vs 48.9%, P =0.036), but the 3-year OS rate had no statistically significant difference (P =0.190).Compared with the RCHOP group, the 3-year PFS was significantly higher in the RFC group (100% vs 48.9%, P =0.029), but the 3-year OS rate had no statistically significant difference (100% vs 85.7% , P =0.285).Of the 36 patients who had received combined chemotherapy, 13 had received rituximab for maintenance treatment, whose 3-year PFS (92.3% vs 58.7%, P =0.025) and OS (100% vs 80.0%, P =0.040) were significantly higher than those not receiving maintenance treatment.Conclusions FL patients with bone marrow involvement may tend to have an onset at young age and intermediate to high FLIPI scores.These patients may benefit from rituximab combined with intensive chemotherapy.Rituximab as maintenance treatment may further improve the survival of these patients.
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