目的 评价利妥昔单抗+环磷酰胺+脂质体阿霉素+长春新碱+泼尼松(R-CDOP样方案)一线治疗合并心血管疾病或危险因素的弥漫大B细胞淋巴瘤(DLBCL)患者的疗效和安全性。方法 收集我院诊断并接受一线R-CDOP样方案化疗,同时合并心血管疾病或危险因素(冠心病病史、高血压、年龄≥60岁、高血脂、糖尿病、肥胖及长期吸烟史)的DLBCL患者临床及生存资料,回顾性分析其临床特征、治疗疗效与不良反应。结果 94例患者纳入研究,其中伴有冠心病者10例,伴有高血压者33例,伴有高脂血症者44例,伴有糖尿病者23例,肥胖者15例,有长期吸烟史者25例,伴有甲亢或甲减者3例。74例患者伴有2项及以上心血管疾病或危险因素。病理分型为生发中心型(GCB)患者34例,非生发中心型(non-GCB)患者60例。全部患者接受中位4.5个周期化疗,总有效率(ORR)和完全缓解率(CRR)率分别为92.6%(87/94)和70.2%(66/94),总体5年无进展生存率(PFS)为71.3%,5年总生存率(OS)为76.9%。GCB患者及non-GCB患者的5年PFS分别为84.6%和63.9%(P＜0.05),5年OS分别为80.6%和74.6%(P=0.407),无统计学差异。全组人群中Ⅲ～Ⅳ度中性粒细胞减少、血小板减少发生率分别为53.2%(50/94)和3.2%(3/94)。19例患者出现Ⅰ～Ⅱ度心脏事件,未出现Ⅲ～Ⅳ度需要紧急治疗或中止化疗的心脏事件,未见化疗相关的远期心脏事件。结论 对于伴有心血管疾病或相关危险因素的DLBCL患者,应用含脂质体多柔比星的CDOP或R-CDOP方案进行一线治疗疗效确切,安全性良好。
Abstract
OBJECTIVE To evaluate the efficacy and safety profile of first-line R-CDOP(rituximab, cyclophosphamide, pegylated liposomal doxorubicin,vincristine, and prednisone) like regimen in diffuse large B-cell lymphoma (DLBCL) with cardiovascular diseases or risk factors. METHODS DLBCL Patients who were diagnosed with at least one cardiovascular disease/risk factor and received first-line R-CDOPlike chemotherapy in our institute between January 2010 and November 2016 were collected. Cardiovascular diseases/risk factors were referred as:coronary heart disease, hypertension, age ≥60, hyperlipidemia, diabetes mellitus, obesity, history of smoking, and hypothyroidism/hyperthyroidism. Chemotherapy in our institute were retrospectively reviewed. RESULTS A total of 94 DLBCL patients were recruited. All enrolled patients had history of a cardiovascular disease or presented a high-risk group of developing cardiovascular diseases:coronary heart disease 10 cases, hypertension 33 cases, hyperlipidemia 44 cases, diabetes mellitus 23 cases, obesity 15 cases, history of smoking 25 cases, hypothyroidism/hyperthyroidism 3 cases. A total of 74 patients had more than one cardiovascular disease or risk factors. A total of 34 patients were germinal center B-cell subtype(GCB) and 60 were non-germinal center B-cell subtype(non-GCB). First-line R-CDOP like chemotherapy was given at a median cycle of 4.5 (range, 2-8). Overall response rate(ORR) and complete response rate (CRR) were 92.6%(87/94) and 70.2%(66/94) for the whole group. 5-Year progression-free survival (PFS) and overall survival(OS) rates were 71.3% and 76.9% for overall. For GCB subtype and non-GCB subtype, 5-year PFS rates were 84.6% and 63.9% respectively(P＜0.05), and 5-year OS rates were 80.6% and 74.6%,respectively(P=0.407). Grade Ⅲ/Ⅳ neutropenia and thrombocytopenia were documented in 53.2%(50/94) and 3.2% (3/94) of patients. 19 (20.2%) patients developed grade Ⅰ/Ⅱ cardiotoxicity. There was no grade Ⅲ/Ⅳ cardiac event causing chemotherapy delay or break off. No further cardiotoxicity occurred neither during follow-up. CONCLUSION PLD-containing first-line R-CDOP like regimen is demonstrated as a highly effective and much tolerable alternative for DLBCL patients with cardiovascular diseases/risk factors.
关键词
淋巴瘤 /
大B细胞 /
弥漫 /
心血管疾病 /
脂质体多柔比星 /
疗效 /
不良反应
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Key words
lymphoma /
large B-cell /
diffuse /
cardiovascular disease /
pegylated liposomal doxorubicin /
efficacy /
adverse reaction
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