长春新碱和长春地辛治疗弥漫性大B细胞淋巴瘤的临床评价
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摘要
目的以长春地辛(VDS)取代长春新碱(VCR)组成RCHVP(利妥昔单抗、环磷酰胺、多柔比星、长春地辛及泼尼松)方案,从疗效、不良反应及药物经济学方面比较其与RCHOP(利妥昔单抗、环磷酰胺、多柔比星、长春新碱及泼尼松)方案治疗弥漫性大B细胞淋巴瘤(DLBCL)的区别。方法收集2013年11月至2017年2月接受传统RCHOP或RCHVP化疗的DLBCL患者83例,分析其疗效、不良反应及成本-效果。结果 RCHVP方案有效率及临床受益率与RCHOP方案相比,差异无统计学意义(P>0.05);RCHVP组完全缓解率显著低于RCHOP组(58.54%vs 78.57%,P<0.05)。RCHVP组较RCHOP组发热性中性粒细胞减少症有下降趋势、肝功能异常有上升趋势,但差异无统计学意义(P>0.05)。RCHOP方案成本低于RCHVP方案。结论 RCHVP方案有效率及临床受益率与RCHOP方案相当,但完全缓解率不及RCHOP方案,且RCHOP方案成本更低,因此不推荐VDS替代VCR治疗DLBCL。但RCHVP方案在引发发热性中性粒细胞减少症方面的不良反应可能轻于RCHOP方案,对于因骨髓抑制无法耐受RCHOP方案的患者可以考虑VDS替代VCR。
AIM To compare the therapeutic response, safety and pharmacoeconomics of RCHOP(rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) regimen and RCHVP(rituximab, cyclophosphamide, doxorubicin, vindesine and prednisone) regimen in the treatment of diffuse large B-cell lymphoma(DLBCL). METHODS From November 2013 to February 2017, 83 patients with DLBCL were treated with RCHOP or RCHVP regimen. The therapeutic response, safety and cost-effectiveness were analyzed retrospectively. RESULTS The response rate and clinical benefit rate between RCHVP regimen and RCHOP regimen showed no significant difference(P>0.05), the complete response rate of RCHVP regimen was significantly lower than that of RCHOP regimen(58.54% vs 78.57%, P<0.05). Compared with RCHOP regimen, the incidence of febrile neutropenia showed a downward trend in RCHVP regimen. On the contrary, the incidence of abnormal liver function showed an upward trend in RCHVP regimen. However, the difference of febrile neutropenia and abnormal liver function was not significant(P>0.05). The cost of RCHOP regimen was lower than that of RCHVP regimen. CONCLUSION RCHVP regimen has the same efficiency and clinical benefit as RCHOP regimen, but the complete remission rate is lower than that of RCHOP regimen, and the cost of RCHOP regimen is lower. Therefore,vindesine is not recommended to replace vincristine for DLBCL. However, the adverse drug reactions of RCHVP regimen in inducing febrile neutropenia may be less than that of RCHOP regimen. Vindesine may be considered as a substitute for vincristine in patients with poor bone marrow function.
AIM To compare the therapeutic response, safety and pharmacoeconomics of RCHOP(rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) regimen and RCHVP(rituximab, cyclophosphamide, doxorubicin, vindesine and prednisone) regimen in the treatment of diffuse large B-cell lymphoma(DLBCL). METHODS From November 2013 to February 2017, 83 patients with DLBCL were treated with RCHOP or RCHVP regimen. The therapeutic response, safety and cost-effectiveness were analyzed retrospectively. RESULTS The response rate and clinical benefit rate between RCHVP regimen and RCHOP regimen showed no significant difference(P>0.05), the complete response rate of RCHVP regimen was significantly lower than that of RCHOP regimen(58.54% vs 78.57%, P<0.05). Compared with RCHOP regimen, the incidence of febrile neutropenia showed a downward trend in RCHVP regimen. On the contrary, the incidence of abnormal liver function showed an upward trend in RCHVP regimen. However, the difference of febrile neutropenia and abnormal liver function was not significant(P>0.05). The cost of RCHOP regimen was lower than that of RCHVP regimen. CONCLUSION RCHVP regimen has the same efficiency and clinical benefit as RCHOP regimen, but the complete remission rate is lower than that of RCHOP regimen, and the cost of RCHOP regimen is lower. Therefore,vindesine is not recommended to replace vincristine for DLBCL. However, the adverse drug reactions of RCHVP regimen in inducing febrile neutropenia may be less than that of RCHOP regimen. Vindesine may be considered as a substitute for vincristine in patients with poor bone marrow function.
引文
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[5] 徐丽, 吐尔逊江·司拉木, 杜春辉, 等. 非霍奇金淋巴瘤应用CHVP和CHOP治疗方案的临床实验观察[J]. 现代检验医学杂志,2011,26(4):118.
[6] FACTORS A. A predictive model for aggressive non-Hodgkin’s lymphoma. The international non-Hodgkin’s lymphoma prognostic factors project[J]. N Engl J Med,1993,329(14):987.
[2] LEE C T, HUANG Y W, YANG C H, et al. Drug delivery systems and combination therapy by using vinca alkaloids[J]. Curr Top Med Chem,2015,15(15):1491
[3] 刁连君. 长春地辛组成CHOP方案治疗非霍奇金淋巴瘤临床观察[J]. 中国社区医师:医学专业半月刊,2009,11(7):37.
[4] 李骏, 柴铁, 李伟. 长春地辛组成CHOP方案治疗非霍奇金淋巴瘤临床观察[J]. 中华肿瘤防治杂志,2004,11(11):1201.
[5] 徐丽, 吐尔逊江·司拉木, 杜春辉, 等. 非霍奇金淋巴瘤应用CHVP和CHOP治疗方案的临床实验观察[J]. 现代检验医学杂志,2011,26(4):118.
[6] FACTORS A. A predictive model for aggressive non-Hodgkin’s lymphoma. The international non-Hodgkin’s lymphoma prognostic factors project[J]. N Engl J Med,1993,329(14):987.