利妥昔单抗不同联合方案在老年惰性B细胞淋巴瘤中的疗效比较
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摘要
目的比较利妥昔单抗联合自然杀伤(NK)细胞生物疗法或化疗在老年惰性B细胞淋巴瘤(i NHL)患者中的疗效和不良反应。方法收集2008年1月至2011年1月于我院血液科接受治疗的61例老年i NHL患者的临床资料。入组患者根据治疗方案的不同分为观察组25例(利妥昔单抗+NK细胞)和对照组36例(利妥昔单抗+CHOP化疗方案)两组。比较两组治疗前、治疗1~4疗程后的白细胞总数、淋巴细胞数量、淋巴细胞比例,近期疗效及5年无进展生存时间(PFS)及治疗过程中的不良反应。结果两组患者治疗1~4疗程后的白细胞总数、淋巴细胞数量、淋巴细胞比例,近期治疗总有效率,5年PFS组间比较,差异均无统计学意义(P>0.05);但观察组感染、中性粒细胞减少、血小板减少发生率均显著低于对照组,差异有统计学意义(P<0.05)。治疗后观察组患者的CD4+、CD4+/CD8+及NK细胞比例明显高于对照组(P<0.05),而CD8+比例低于对照组(P<0.05)。结论相对于R-CHOP联合化疗,利妥昔单抗+NK细胞疗法在老年i NHL患者中疗效相当,且不良反应更少,有一定的应用价值。
Objective To compare the efficacy and adverse reaction between of rituxan( RTX) combined with NK cells and chemotherapy for elder patients with indolent B-cell non-Hodgkin lymphoma( i NHL). Methods The clinical information of elder patients with i NHL treated in our hospital from January 2008 to January 2011 was retrospectively analyzed. The patients were divided into two groups according to the therapeutic regimens: observe group( RTX+NK cells,n = 25) and control group( RTX+CHOP,n = 36).The baseline data,the number of white blood cells,lymphocytes,lymphocyte proportion before and after the treatment,the recent curative effect,5 years progression-free survival( PFS) and adverse reaction in the process of treatment were compared between the two groups. Results No significant difference in the number of white blood cells and lymphocytes,lymphocyte proportion,recent curative effect and 5 year PFS after 1 ~ 4 courses of the treatments was found between the two groups( P > 0. 05). However,the incidence of infection,neutropenia and thrombocytopenia in the observe group was significantly lower than those in the control group( P < 0. 05). After the treatment,the proportion of CD4+,CD4+ / CD8+ and NK in the observe group was significantly higher than that in the control group while the proportion of CD8+ in the observe group was lower than that in the control group( P < 0. 05). Conclusion Compared with RCHOP chemotherapy,the treatment of RTX+NK cells has a close efficacy but lower incidence of adverse reactions in the treatment of elder i NHL patients. It has a certain clinical value.
Objective To compare the efficacy and adverse reaction between of rituxan( RTX) combined with NK cells and chemotherapy for elder patients with indolent B-cell non-Hodgkin lymphoma( i NHL). Methods The clinical information of elder patients with i NHL treated in our hospital from January 2008 to January 2011 was retrospectively analyzed. The patients were divided into two groups according to the therapeutic regimens: observe group( RTX+NK cells,n = 25) and control group( RTX+CHOP,n = 36).The baseline data,the number of white blood cells,lymphocytes,lymphocyte proportion before and after the treatment,the recent curative effect,5 years progression-free survival( PFS) and adverse reaction in the process of treatment were compared between the two groups. Results No significant difference in the number of white blood cells and lymphocytes,lymphocyte proportion,recent curative effect and 5 year PFS after 1 ~ 4 courses of the treatments was found between the two groups( P > 0. 05). However,the incidence of infection,neutropenia and thrombocytopenia in the observe group was significantly lower than those in the control group( P < 0. 05). After the treatment,the proportion of CD4+,CD4+ / CD8+ and NK in the observe group was significantly higher than that in the control group while the proportion of CD8+ in the observe group was lower than that in the control group( P < 0. 05). Conclusion Compared with RCHOP chemotherapy,the treatment of RTX+NK cells has a close efficacy but lower incidence of adverse reactions in the treatment of elder i NHL patients. It has a certain clinical value.
引文
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[6]Meng F,Zhong D,Zhang L,et al.Efficacy and safety of rituximab combined with chemotherapy in the treatment of diffuse large B-cel lymphoma:a meta-analysis[J].Int J Clin Exp Med,2015,8(10):17515-17522.
[7]Ureshino H,Ando T,Kojima K,et al.Rituximab-containing Chemotherapy(R-CHOP)-induced Kaposi's Sarcoma in an HIV-negative Patien with Diffuse Large B Cell Lymphoma[J].Intern Med,2015,54.[8](24):3205-3208.
[8]Plaza JA,Kacerovska D,Stockman DL,et al.The histomorphologic spectrum of primary cutaneous diffuse large B-cell lymphoma:a study of 79 cases[J].Am J Dermatopathol,2011,33(7):649-655,quiz656-658.
[9]Petkovic.Current trends in the treatment of primary mediastinal large B-cell lymphoma-an overview[J].Contemp Oncol(Pozn),2015,19(6):428-435.
[10]Challa-Malladi M,Lieu YK,Califano O,et al.Combined genetic inactivation ofβ2-Microglobulin and CD58 reveals frequent escape from immune recognition in diffuse large B cell lymphoma[J].Cancer Cell,2011,20(6):728-740.
[11]Kim JK,Chung JS,Shin HJ,et al.Influence of NK cell count on the survival of patients with diffuse large B-cell lymphoma treated with R-CHOP[J].Blood Res,2014,49(3):162-169.
[2]Li J,Fu R,Yang L,et al.miR-21 expression predicts prognosis in diffuse large B-cell lymphoma[J].Int J Clin Exp Pathol,2015,8(11):15019-15024.
[3]缪继东.吉西他滨联合奥沙利铂治疗复发性B细胞淋巴瘤的近期疗效观察[J].实用医院临床杂志,2012,9(5):197-199.
[4]Grille S,Moreno M,Bascuas T,et al.Salmonella enterica serovar Typhimurium immunotherapy for B-cell lymphoma induces broad antitumour immunity with therapeutic effect[J].Immunology,2014,143(3):428-437.
[5]H9mberg N,Adam C,Riedel T,et al.CD40-independent natural killer-cell help promotes dendritic cell vaccine-induced T-cell immunity against endogenous B-cell lymphoma[J].Int J Cancer,2014,135(12):2825-2833.
[6]Meng F,Zhong D,Zhang L,et al.Efficacy and safety of rituximab combined with chemotherapy in the treatment of diffuse large B-cel lymphoma:a meta-analysis[J].Int J Clin Exp Med,2015,8(10):17515-17522.
[7]Ureshino H,Ando T,Kojima K,et al.Rituximab-containing Chemotherapy(R-CHOP)-induced Kaposi's Sarcoma in an HIV-negative Patien with Diffuse Large B Cell Lymphoma[J].Intern Med,2015,54.[8](24):3205-3208.
[8]Plaza JA,Kacerovska D,Stockman DL,et al.The histomorphologic spectrum of primary cutaneous diffuse large B-cell lymphoma:a study of 79 cases[J].Am J Dermatopathol,2011,33(7):649-655,quiz656-658.
[9]Petkovic.Current trends in the treatment of primary mediastinal large B-cell lymphoma-an overview[J].Contemp Oncol(Pozn),2015,19(6):428-435.
[10]Challa-Malladi M,Lieu YK,Califano O,et al.Combined genetic inactivation ofβ2-Microglobulin and CD58 reveals frequent escape from immune recognition in diffuse large B cell lymphoma[J].Cancer Cell,2011,20(6):728-740.
[11]Kim JK,Chung JS,Shin HJ,et al.Influence of NK cell count on the survival of patients with diffuse large B-cell lymphoma treated with R-CHOP[J].Blood Res,2014,49(3):162-169.