R-CHOP治疗老年弥漫性大B细胞淋巴瘤患者疗效及其预后相关影响因素分析OACSTPCD
Analysis of efficacy and prognostic factors of R-CHOP in treatment of elderly patients with diffuse large B-cell lymphoma
目的 探讨利妥昔单抗+环磷酰胺+多柔比星+长春新碱+泼尼松(R-CHOP)治疗老年弥漫性大B细胞淋巴瘤(DLBCL)患者疗效及其预后的相关影响因素.方法 回顾性选取2018年1月—2023年3月收治的107例老年DL-BCL作为研究对象,统计分析R-CHOP近期疗效和预后情况,并采用多因素回归分析影响疗效及其预后的相关因素.结果 107例老年DLBCL患者,经过3个疗程治疗后,ORR为77.57％(83/107),其中完全缓解44例(41.12％),部分缓解39例(36.45％).截至随访时间2024年3月,有31例(28.97％)患者在随访期间发生疾病进展或治疗相关不良事件导致的死亡;采用多分类有序Logistic回归分析显示,年龄＞70岁(OR=2.628,P=0.020)、Ann Arbor分期Ⅲ～Ⅳ期(OR=4.004,P=0.003)、骨髓侵犯(OR=3.749,P=0.002)、LDH 升高(OR=3.616,P=0.002)、β2-MG 升高(OR=3.137,P=0.010)均为影响老年DLBCL患者R-CHOP治疗后疗效的独立危险因素(P＜0.05);采用二元Logistic分析发现,年龄＞70 岁(OR=5.427,P=0.006)、活化 B 细胞样亚型(OR=5.777,P=0.014)、Ann Arbor 分期 Ⅲ～Ⅳ 期(OR=3.465,P=0.026)、骨髓侵犯(OR=3.792,P=0.023)、治疗后无反应(OR=5.688,P=0.012)均为影响老年 DLBCL 患者R-CHOP治疗后预后的独立危险因素(P＜0.05).结论 年龄＞70岁、活化B细胞样亚型、Ann Arbor分期Ⅲ～Ⅳ期、治疗后无反应可能为影响老年DLBCL患者R-CHOP治疗后预后的独立危险因素,临床上可基于这类因素进行风险分层,以改善患者的预后.
Objective To explore the therapeutic effects of rituximab+cyclophosphamide+doxorubicin+vincristine+prednisone(R-CHOP)in the treatment of elderly patients with diffuse large B-cell lymphoma(DLBCL)and the factors related to prognosis.Methods A total of 107 elderly DLBCL patients admitted from January 2018 to March 2023 were retrospectively en-rolled as the research subjects.The short-term efficacy of R-CHOP and the prognosis of patients were statistically analyzed.Mult-ivariate regression analysis was used to analyze the related factors affecting the curative effect and prognosis.Results In the 107 elderly patients with DLBCL,ORR was 77.57％(83/107)after three courses of treatment,including 44 ones with complete re-mission(41.12％)and 39 ones with partial remission(36.45％).As of March 2024,31 patients(28.97％)had died from dis-ease progression or treatment-related adverse events during follow-up.Multiple classification ordered logistic regression analysis showed that age＞70 years old(OR=2.628,P=0.020),Ann Arbor stage Ⅲ to Ⅳ(OR=4.004,P=0.003),bone marrow in-vasion(OR=3.749,P=0.002),and elevated LDH(OR=3.616,P=0.002),and elevated β2-MG(OR=3.137,P=0.010)were independent risk factors for the efficacy of R-CHOP treatment in elderly DLBCL patients(P＜0.05).Binary logistic analy-sis showed that age＞70 years old(OR=5.427,P=0.006),activated B-cell-like subtype(OR=5.777,P=0.014),Ann Ar-bor stage Ⅲ to Ⅳ(OR=3.465,P=0.026),bone marrow invasion(OR=3.792,P=0.023)and no response after treat-ment(OR=5.688,P=0.012)were independent risk factors affecting the prognosis of elderly DLBCL patients after R-CHOP treatment(P＜0.05).Conclusion Age＞70 years old,activated B-cell-like subtype,Ann Arbor stage Ⅲ to Ⅳ,and non-re-sponse after treatment are independent risk factors affecting the prognosis of elderly DLBCL patients after R-CHOP treatment.Risk stratification based on these factors should be performed clinically to improve the prognosis of patients.
王美佳;刘虹伶;杨利华;杨伟荣
四川大学华西医院上锦医院/成都上锦南府医院血液科,四川成都 611730四川省司法警官总医院内三科,四川成都 610225
老年弥漫性大B细胞淋巴瘤利妥昔单抗疗效预后影响因素
elderlydiffuse large B-cell lymphomarituximabcurative effectprognosisinfluencing factor
《老年医学与保健》 2024 (003)
655-661 / 7
四川省科技计划项目(2018SZ0200);成都市卫生健康委员会课题(2021446)
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