老年人难治弥漫大B细胞淋巴瘤不同挽救方案疗效分析

摘要

Objective To evaluate the efficacy and toxicities of gemcitabine plus oxaliplatin with R-GemOx or without (GemOx) rituximab regimen in the treatment of relapsed or refractory diffuse large B-cell lymphoma in elderly patients.Methods A total of 39 patients with relapsed or refractory diffuse large B-cell lymphoma received R-GemOx or GemOx chemotherapy.There were 16 patients in R-GemOx and 23 patients in GemOx group.Patients in both groups received gemcitabine 1000 mg/m2,d1,at land 8 day and oxaliplatin 130 mg/m2,d1 at lday.Patients in R-GemOx additionally received rituximab 375 mg/m2.Every 21-28 days was 1 cycle.The toxicities were evaluated after 1 cycle of chemotherapy.The efficacy was evaluated after 2 cycles of chemotherapy.Results In R-GemOx group,the total response rate was 62.5％,and the clinical benefit rate was 87.5％.In GemOx group,the total response rate was 47.8％,and the clinical benefit rate was 73.9％ There was no significant differences between the two groups.There was a significant difference in the median time-to-progression (TTP) between R-GemOx group (6.4 months) and GemOx group (5.0 months) (P ＜ 0.05).The major toxicities were marrow suppression and gastrointestinal reaction,which had no significant differences between the two groups.Conclusions R-GemOx and GemOx regimen are effective and safe for the elderly patients with relapsed or refractory diffuse large B-cell lymphoma(DLBCL).But the patients with relapsed/refractory DLBCL treated with R-GemOx had a longer median time-to-progression than with GemOx regimen.%目的 探讨美罗华联合吉西他滨和奥沙利铂方案(R-GemOx)和吉西他滨联合奥沙利铂(GemOx)方案挽救治疗老年人复发难治弥漫大B细胞淋巴瘤的疗效和不良反应. 方法 老年复发难治弥漫大B细胞淋巴瘤患者39例,分别接受R-GemOx或GemOx方案化疗,其中R-GemOx组16例、GemOx组23例；吉西他滨1000 mg/m2,静脉滴注,第1天、第8天；奥沙利铂(L-OHP)130mg/m2,静脉滴注,第1天；部分患者经济允许并知情同意情况下,联合使用美罗华375 mg/m2,静脉滴注,用吉西他滨前一天给药.21～28 d为1个周期,完成1个周期化疗后评价不良反应,完成2个周期化疗后评价疗效. 结果 R-GemOx组总有效率(完全缓解率+部分缓解率)为62.5％,临床获益率[完全缓解率+部分缓解率+病情稳定率]为87.5％; GemOx组分别为47.8％和73.9％,差异无统计学意义(P=0.366).R-GemOx组中位疾病进展时间(TTP)为6.4个月,GemOx组中位TTP5.0个月,差异有统计学意义(P＜0.05).两组主要不良反应为骨髓抑制、胃肠道反应,两组间差异无统计学意义. 结论 R-GemOx和GemOx方案挽救治疗老年人复发难治性弥漫大B细胞淋巴瘤安全有效,R-GemOx方案有效率高于GemOx方案,且能达到更长的疾病进展时间.