2023 年第 6 期 第 18 卷

R-CHNP方案治疗弥漫大B细胞淋巴瘤的效果分析

Analysis of therapeutic effect of R-CHNP scheme on diffuse large B-cell lymphoma

作者：彭小娟崔杰段赟姜俊峰王玉虹郭炳涛连粉红

英文作者：Peng Xiaojuan Cui Jie Duan Yun Jiang Junfeng Wang Yuhong Guo Bingtao Lian Fenhong

单位：甘肃省肿瘤医院血液科，兰州730050

英文单位：Department of Hematology Gansu Provincial Cancer Hospital Lanzhou 730050 China

关键词：弥漫大B细胞淋巴瘤；长春瑞滨；周围神经毒性

英文关键词：

• 摘要：

• 目的  探究R-CHNP方案（利妥昔单抗+环磷酰胺+表柔比星+长春瑞滨+泼尼松）治疗弥漫大B细胞淋巴瘤（DLBCL）的效果。方法  选取 2018年8月至2020年8月于甘肃省肿瘤医院血液科就诊的80例初治DLBCL患者，按照随机数字表法分为R-CHNP组和R-CHOP组（利妥昔单抗+环磷酰胺+表柔比星+长春新碱+泼尼松），各40例。所有患者均以3周为1个周期，治疗6个周期。比较2组近期疗效、无进展生存期（PFS），分析患者PFS的影响因素。比较2组不良反应发生情况。结果  治疗6个周期后，R-CHNP组客观缓解率高于R-CHOP组［75.0%（30/40）比52.5%（21/40）］，差异有统计学意义(χ2=4.381，P=0.036)。R-CHNP组中位PFS为36个月，R-CHOP组中位PFS为33个月，生存曲线分析结果显示组间无进展生存率比较差异无统计学意义（P=0.531）。多因素分析结果显示，Ann-Arbor分期、国际预后指数（IPI）评分对DLBCL患者PFS有显著影响（均P＜0.05）。2组患者不良反应在停药或对症治疗后均好转或消失，无治疗相关的死亡事件。R-CHOP组的周围神经病变发生率高于R-CHNP组，且周围神经病变程度较R-CHNP组严重，差异均有统计学意义（均P＜0.05）。结论  R-CHNP方案治疗DLBCL可获得一定效果，其周围神经毒性发生率低且程度较轻；Ann-Arbor分期、IPI评分对患者的长期生存有显著影响。

• Objective    To explore the therapeutic effect of R-CHNP scheme (rituximab, cyclophosphamide, epirubicin, vinorelbine and prednisone) on diffuse large B-cell lymphoma(DLBCL). Methods  From August 2018 to August 2020, 80 patients with DLBCL admitted to Department of Hematology, Gansu Provincial Cancer Hospital were selected. They were divided into the R-CHNP group and the R-CHOP group (rituximab, cyclophosphamide, epirubicin, vincristine and prednisone) according to the random number table method, with 40 cases in each group. All patients were treated for 6 cycles, with 3 weeks as a cycle. The short-term efficacy and progression-free survival (PFS) between the two groups were compared, and the influencing factors of PFS were analyzed. The occurrences of adverse reactions between the two groups were compared. Results  After 6 cycles of treatment, the objective remission rate in R-CHNP group was higher than that in R-CHOP group ［75.0%(30/40) vs 52.5%(21/40)］（χ2=4.381, P=0.036). The median PFS was 36 months in the R-CHNP group and 33 months in the R-CHOP group. The survival curve analysis showed that there was no statistically significant difference in the PFS rate between groups (P=0.531). Multivariate analysis showed that Ann-Arbor stage and International Prognosis Index (IPI) score had significant effect on PFS of DLBCL patients (both P＜0.05). The adverse reactions of patients in the two groups improved or disappeared after drug withdrawal or symptomatic treatment, and there was no treatment-related death event. The incidence of peripheral neuropathy in the R-CHOP group was higher than that in the R-CHNP group, and the degree of peripheral neuropathy was more serious than that in the R-CHNP group (both P＜0.05). Conclusions  R-CHNP have certain effect on DLBCL, and the incidence rate and degree of peripheral neurotoxicity are low. Ann-Arbor stage and IPI score have significant influence on the long-term survival of patients.