R-CHOP和CHOP方案治疗早期原发性胃弥漫大B细胞淋巴瘤的疗效和毒性比较

摘要

Objective We evaluated the efficacy of R-CHOP and CHOP in first-line treatment of early primary gastric dif-fuse large B-cell lymphoma. Methods Sixteen patients with early (stage I-II) gastric diffuse large B-cell lymphoma received R-CHOP immunochemotherapy as first-line treatment. The R-CHOP regimen consisted of rituximab (375 mg·m-2 intra-venously) on day 1, cyclophosphamide (750 mg·m-2 intravenously) on day 2, doxorubicin (50 mg·m-2 intravenously) on day 2, vincristine (1.4 mg·m-2 intravenously) on day 2 and prednisone (100 mg orally) on days 2 ~ 6. Another group of 16 patients with early (stage I ~ II) gastric diffuse large B-cell lymphoma received CHOP chemotherapy as first-line treatment. A non-randomized comparison of efficacy was conducted between R-CHOP and CHOP group. The CHOP regimen consisted of cy-clophosphamide (750 mg·m-2 intravenously) on day 1, doxorubicin (50 mg·m-2 intravenously) on day 1, vincristine (1.4 mg·m-2 intravenously) on day 1 and prednisone (100 mg orally) on days 1 ~ 5. The efficacy and adverse events of both regimens were evaluated and compared. Results All the 32 patients were evaluated. In the R-CHOP group, the treatment consisted of 2 ~ 6 cycles (median, 4 cycles) of immunochemotherapy, and eight patients achieved complete remission (CR), six patients partial re-mission (PR), one patient stable disease (SD), one patient progression disease (PD). The responsive rate of R-CHOP was 87.5% (14/16). In the CHOP group, the treatment consisted of 2-6 cycles (median, 4 cycles) of chemotherapy, and six patients achieved CR, five PR, two patients SD, three patients PD. The responsive rate of CHOP was 68.7% (11/16). The response rate was higher in the R-CHOP group than in the CHOP group, and the difference was statistically significant. The adverse events in both two groups consisted of myelosuppression, infection, mucositis, gastrointestinal reactions, fever, liver and kidney dysfunction, neuro-toxicity and allergic reactions. All the adverse events can be rapidly eased after symptomatic treatment. Except for fever, there was no significant difference in the incidence of adverse events between R-CHOP group and CHOP group. Conclusion R-CHOP was more effective than CHOP regimen as first-line treatment of early gastric diffuse large B-cell lymphoma, and there was no significant difference in the incidence of toxicities between the two regimens.%　　目的探讨R-CHOP方案治疗早期原发性胃弥漫大B细胞淋巴瘤的临床疗效及不良反应。方法回顾性分析和比较采用R-CHOP方案（16例）以及CHOP方案（16例）治疗的初治早期（Ⅰ~Ⅱ期）胃弥漫大B细胞淋巴瘤患者的近期疗效及不良反应。结果R-CHOP组患者化疗后CR 8例，PR 6例，SD 1例，PD 1例，有效率为87.5%（14/16）；CHOP组患者化疗后CR 6例，PR 5例，SD 2例，PD 3例，有效率为68.7%（11/16），R-CHOP组有效率高于CHOP组（P<0.05）。两组的不良反应主要为骨髓抑制、感染、粘膜炎、胃肠道反应、发热、肝功能损害。神经毒性及过敏反应等，经对症治疗后都能较快缓解，两组的不良反应发生率差异无统计学意义。结论R-CHOP方案治疗早期胃弥漫大B细胞淋巴瘤的临床疗效优于CHOP方案，不良反应无明显差异。