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目的:回顾性分析一线序贯含铂方案治疗年轻弥漫大B细胞淋巴瘤(diffuse large B-cell Lymphoma,DLBCL)的疗效和安全性。方法:选择郑州大学附属肿瘤医院2005年1月至2012年6月收治的、符合入组标准的年轻初治DLBCL患者,分为标准方案和序贯含铂方案组,χ~2检验比较两组的缓解率,Kaplan-Meier生存分析比较两组的5年生存率,Cox回归多因素分析生存相关影响因素,亚组分析序贯含铂方案最佳获益人群。结果:入组331例患者,包括序贯含铂方案129例和标准方案202例。序贯含铂方案较标准方案获得较高的完全缓解率(complete remission rate,CRR)(80%vs.63%,P=0.001),较高的5年无进展生存(progression free survival,PFS)(60%vs.50%,P=0.014)和总生存(overall survival,OS)(70%vs.58%,P=0.016)。多因素生存分析显示序贯含铂方案治疗是PFS(HR=0.635,P=0.012)和总OS(HR=0.625,P=0.021)独立的影响因素。亚组分析显示预后良好和未联合应用利妥昔单抗的患者是序贯含铂方案的最佳获益人群。两组不良反应发生无显著性差异。结论:一线序贯含铂方案能够改善年轻DLBCL患者的疗效,且安全性好;预后良好和未联合应用利妥昔单抗的患者是最佳获益人群。
Objective: To retrospectively analyze the efficacy and safety of first-line sequential platinum regimen in the treatment of diffuse large B-cell lymphoma (DLBCL). Methods: The patients with newly diagnosed DLBCL in our hospital affiliated to Tumor Hospital of Zhengzhou University from January 2005 to June 2012 were enrolled in the standard protocol and sequential platinum-containing regimen. Chi-square test was used to compare the two groups , Kaplan-Meier survival analysis was used to compare the 5-year survival rate of the two groups, Cox regression multivariate analysis of survival-related factors, subgroup analysis of the best benefit of sequential platinum-containing population. Results: A total of 331 patients enrolled, including 129 sequential platinum-containing regimens and 202 standard regimens. The sequential platinum-containing regimen achieved a higher complete remission rate (CRR) (80% vs.63%, P = 0.001) and a higher 5-year progression free survival (PFS) than the standard regimen (60% vs. 50%, P = 0.014) and overall survival (70% vs. 58%, P = 0.016). Multivariate survival analysis showed that the sequential platinum-containing regimen was an independent influencing factor for PFS (HR = 0.635, P = 0.012) and total OS (HR = 0.625, P = 0.021). Subgroup analyzes showed that patients with good prognosis and no concurrent rituximab were the best beneficiaries of the sequential platinum regimen. There was no significant difference between the two groups. CONCLUSIONS: The first-line sequential platinum regimen can improve the efficacy and safety of young DLBCL patients; patients with good prognosis and without rituximab are the best beneficiaries.