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目的 :CHOP方案是目前治疗弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)的标准方案。CD20单抗美罗华(rituximab,R)与CHOP方案联合后,R-CHOP方案的治疗效果进一步的提高。本研究着重分析治疗过程中药物的每疗程剂量、时间剂量强度等与治疗结果的关系。方法:回顾性研究经(R)-CHOP方案治疗的DLBCL初诊患者52例。分析国际预后指数(IPI)评分、CHOP方案中的强的松、环磷酰胺和阿霉素的平均每疗程剂量强度(DIPC)和平均每周剂量强度(DIPW)与疗效的关系。结果:病例的中位随诊时间为34个月(6~95个月),在经Pearson Chi-Square统计后发现,患者起病时的强的松DIPW<166.7mg/m2、IPI评分、Ann Arbor分期(A或B)可以影响患者的完全缓解(CR)率(均P<0.05)。在将上述与CR有关的因素进行Logistic回归分析后,发现强的松DIPW<166.7 mg/m2和IPI积分为与CR相关的独立预后因素(均P<0.05)。对患者总生存(OS)资料进行Kaplan-Meier分析发现,经Log-rank检验后,IPI积分、阿霉素<16.7 mg/(m2·周)、环磷酰胺<250 mg/(m2·周)与DLBCL患者的OS有关。在将上述与OS有关的因素进行Cox regression分析后,发现阿霉素<16.7 mg/(m2·周)、IPI积分为与OS相关的独立预后因素(P均<0.05)。结论:对于用(R)-CHOP方案的初诊DLBCL患者,不但起病时的IPI积分、Ann Arbor分期(A或B)等与治疗结果相关,而且治疗因素如环磷酰胺和阿霉素的平均每周剂量强度也影响预后。在治疗过程中,应尽可能地按预定治疗方案给药。
OBJECTIVE: The CHOP regimen is the current standard protocol for the treatment of diffuse large B cell lymphoma (DLBCL). After the combination of rituximab (R) and CHOP regimen with CD20 monoclonal antibody, the therapeutic effect of R-CHOP regimen was further improved. This study focuses on the analysis of the course of treatment of drug dose per treatment, the time dose intensity and the relationship between the treatment results. Methods: A retrospective study of 52 patients with newly diagnosed DLBCL treated with (R) -CHOP regimen was performed. The International Prognostic Index (IPI) score, prednisone, cyclophosphamide and doxorubicin in the CHOP regimen were analyzed for the mean duration of treatment dose (DIPC) and mean weekly dose intensity (DIPW) in relation to efficacy. Results: The median follow-up time was 34 months (range 6 to 95 months). Pearson Chi-Square statistics showed prednisone DIPW <166.7 mg / m2, IPI score, Ann The Arbor staging (A or B) can affect the patient’s complete remission (CR) rates (all P <0.05). Logistic regression analysis of these CR-related factors revealed prednisone DIPW <166.7 mg / m2 and IPI scores as independent prognostic factors associated with CR (all P <0.05). Kaplan-Meier analysis of OS data showed that IPI scores of Adriamycin <16.7 mg / (m 2 · weeks), cyclophosphamide <250 mg / (m 2 · Weeks) after Log-rank test, And DLBCL patients with OS. After Cox regression analysis of these OS-related factors, we found that doxorubicin was less than 16.7 mg / (m2 · week). The IPI scores were independent prognostic factors associated with OS (all P <0.05). CONCLUSIONS: Not only the IPI score at onset, the Ann Arbor stage (A or B), etc., are associated with treatment outcome in newly diagnosed DLBCL patients using the (R) -CHOP regimen, but also treatment factors such as cyclophosphamide and doxorubicin The weekly dose intensity also affects the prognosis. In the course of treatment, should be scheduled treatment options as much as possible.