摘要
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。
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 ehemotherapies. 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 rituxirnab, 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, cyelophosphamide, epirubiein, 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 nmrrow involvement ,nay 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.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第44期3593-3597,共5页
National Medical Journal of China
基金
国家自然科学基金（81370632、81200395）
关键词
淋巴瘤
滤泡型
药物疗法
联合
骨髓侵犯
利妥昔单抗
Lymphoma, follicular
Drug therapy, combination
Bone marrow involvement
Rituximab
