Gemox、ICE、DICE方案治疗复发难治性弥漫大B细胞淋巴瘤的疗效观察

摘要

Objective:To evaluate the resPonse and side effects of Gemox,DICE and ICE regiments in the treat-ment of recurrent or refractory DLBCL Patients. Methods:A total of 65 Patients with recurrent or refractory DLBCL were randomized into three grouPs:Gemox grouP(17 Patiens),DICE grouP(26 Patiens)and ICE grouP(22 Pa-tiens). The resPonse toxicity,2 years overall survival rate( OS),Progression-free survival( PFS),overall remission ( OR)were comPared in the three grouPs . Results:GrouP Gemox,DICE and ICE,the overall remission( OR)were 47. 06%,61. 54% and 45. 45%(P<0. 05). Progression-free survival(PFS)were(12. 82 ± 3. 74)months,(18. 35 ± 3. 19)months and(15. 81 ± 2. 11)months. The 2 years overall survival rate( OS)were 23. 53%,46%,9. 09%. There were not significant differences(P>0. 05). The main toxicity included hematologic toxity,infection,abnormal liver function,PeriPheral neuritis,gastritis and abnormal myocardial enzyme. Abnormal liver function,PeriPheral neuri-tis and abnormal myocardial enzyme was no Predominance in three grouPs,but in three grouPs,the highest incidence in hematologic toxity,infection were in ICE grouP(P<0. 05),gastritis were hightest in DICE grouP. Conclusion:A-mong Gemox grouP,DICE grouP and ICE grouP,overall remission( OR)of DICE regimen is best for the treatment of recurrent or refractory DLBCL. Hematologic toxity,infection was lower than ICE grouP and Gemox grouP,but gastritis in DICE regimen are heighest in three regimens.%目的：比较Gemox、DICE及ICE三种二线方案治疗复发难治性弥漫大B细胞淋巴瘤的疗效和不良反应。方法：收录2008年-2012年期间我院复发难治性弥漫大B细胞淋巴瘤患者共65例，根据不同的治疗方案分为Gemox组（17例）、DICE组（26例）、ICE组（22例）。观察每组的OR、PFS、OS率（2年）及主要不良反应。结果：Gemox组、DICE组、ICE组OR率分别为47.06%、61.54%和45.45%，有显著差异（ P＜0.05），三组PFS分别为（12.82±3.74）、（18.35±3.19）和（15.81±2.11）个月，OS 率（2年）分别为23.53%、46%、9.09%，P值分别为0.07和0.21，无明显差别。三组主要的不良反为血液学毒性、感染、肝功异常、末梢神经炎、胃炎、心肌酶升高，其中肝功异常、末梢神经炎、心肌酶升高三组无明显差别，P＞0.05，但血液学毒性、感染的发生率均ICE组最高，而胃炎的发生率DICE最高，有显著差异（ P＜0.05）。结论：在治疗复发难治性弥漫大B细胞淋巴瘤中三组治疗方案PFS、2年OS率无明显差别，但OR率DICE方案最高，ICE方案最低。三组间主要不良反应肝功异常、末梢神经炎、心肌酶反应无差别；血液学毒性、感染发生率ICE组最高；胃炎DICE组最高。DICE方案与ICE方案及Gemox方案比较具有OR率高而感染、血液学毒性发生率低的特点，虽然胃炎发生率最高，但均可以耐受。