目的评估剂量调整的依托泊苷、泼尼松、长春新碱、环磷酰胺、多柔比星联合利妥昔单抗方案(dose-adjusted etoposide,doxorubicin and cyclophosphamide with vincristine,prednisone and rituximab without radiotherapy,DA-EPOCH-R)对...目的评估剂量调整的依托泊苷、泼尼松、长春新碱、环磷酰胺、多柔比星联合利妥昔单抗方案(dose-adjusted etoposide,doxorubicin and cyclophosphamide with vincristine,prednisone and rituximab without radiotherapy,DA-EPOCH-R)对比改良的利妥昔单抗、环磷酰胺、长春新碱、阿霉素、大剂量甲氨蝶呤、亚叶酸钙(cyclophosphamide,vincristine,doxorubicin,high-dose methotrexate,CODOX-M)/异环磷酰胺、依托泊苷、大剂量阿糖胞苷联合利妥昔单抗(ifosfamide,etoposide,high-dose cytarabine and rituximab,IVAC-R)方案治疗艾滋病(acquired immune deficiency syndrome,AIDS)相关伯基特淋巴瘤(burkitt lymphoma,BL)患者的疗效和安全性。方法本研究为一项单中心回顾性队列研究,纳入2010年12月至2022年6月期间于首都医科大学附属北京地坛医院诊断为艾滋病相关伯基特淋巴瘤患者41例,26例患者接受DA-EPOCH-R方案治疗(观察组),15例患者接受改良CODOX-M/IVAC-R方案治疗(对照组),收集患者的临床特征、实验室检查、不良反应和临床疗效,采用多变量Cox比例风险模型评估预后相关风险因素。结果41例入组患者中,97.6%为男性,中位年龄为43岁,41.5%的患者基线中位CD4^(+)细胞计数低于200个/μL。中位随访17个月,观察组患者的完全缓解(complete response,CR)率显著高于对照组(57.7%vs.33.3%),观察组患者中位总生存期(overall survival,OS)与对照组相比差异有统计学意义,分别为18.0个月和6.7个月(95%CI:5.0~16.6)(P<0.001);而观察组治疗相关的病死率却显著低于对照组(0%vs 26.7%,P<0.01)。结论DA-EPOCH-R方案治疗AIDS相关伯基特淋巴瘤较改良CODOX-M/IVAC-R方案具有更优的生存获益且安全性良好,可作为该类患者的优选化学药物治疗方案。展开更多
原发性纵隔大B细胞淋巴瘤(primary mediastinal large B-cell lymphoma,PMBCL)是弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的一种特殊亚型,好发于年轻女性[1-2]。PMBCL是一种罕见的癌症,目前对复发/难治性PMBCL的治疗...原发性纵隔大B细胞淋巴瘤(primary mediastinal large B-cell lymphoma,PMBCL)是弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的一种特殊亚型,好发于年轻女性[1-2]。PMBCL是一种罕见的癌症,目前对复发/难治性PMBCL的治疗一般与其他复发/难治性DLBCL治疗相同,治疗方案主要包括:R-DA-EPOCH(利妥昔单抗+依托泊苷+泼尼松+长春新碱+环磷酰胺+阿霉素),DHAP(地塞米松+阿糖胞苷+顺铂),ESHAP(依托泊苷+甲基强的松+阿糖胞苷+铂剂),GDP(吉西他滨+地塞米松+顺铂),以及mini-beam(卡莫司汀+依托泊苷+阿糖胞苷+马法兰)[3-4]。展开更多
Background: To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin,...Background: To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Waldeyer’s ring diffuse large B-cell lymphoma (WR-DLBCL) at a single institution. Methods: This retrospective study included 115 newly diagnosed patients with WR-DLBCL, of whom 68 patients received R-CHOP, and 47 patients received DA-EPOCH-R as their first-line treatment. The baseline features of the two groups were well balanced using a 1:1 propensity score matching method, and a total of 84 cases were obtained, including respective 42 cases in the R-CHOP and DA-EPOCH-R groups, for further survival and prognosis analysis. The primary objectives included progression-free survival (PFS) and overall survival (OS). Results: During a median follow-up of 45 months, there were nine (21.4%) deaths in the R-CHOP group and two (4.8%) in the DA-EPOCH-R group. Kaplan-Meier analysis showed statistically significant improvements in PFS and OS in patients with DA-EPOCH-R compared with those treated with R-CHOP (log-rank test, P = 0.025 and P = 0.035, respectively). The 2-year PFS and OS rates in the DA-EPOCH-R group were 90.1% (95% confidence interval [CI]: 81.4-99.8%) and 95.2% (95% CI: 89.0-100.0%), respectively, and 80.5% (95% CI: 69.3-93.6%) and 90.5% (95% CI: 52.8-99.8%) in the R-CHOP group. Patients without B symptoms and elevated lactate dehydrogenase levels had a higher PFS in the DA-EPOCH-R group, with P values of 0.038 (hazard ratio [HR]: 0.11;95% CI: 0.01-0.88) and 0.042 (HR: 0.19;95% CI: 0.04-0.94), respectively. There were no statistically significant differences in clinical responses and treatment-related toxicities between the two groups. Conclusion: Compared with patients received R-CHOP, those treated by DA-EPOCH-R had superior PFS, OS, and controlled toxicity in patients with WR-DLBCL.展开更多
文摘目的评估剂量调整的依托泊苷、泼尼松、长春新碱、环磷酰胺、多柔比星联合利妥昔单抗方案(dose-adjusted etoposide,doxorubicin and cyclophosphamide with vincristine,prednisone and rituximab without radiotherapy,DA-EPOCH-R)对比改良的利妥昔单抗、环磷酰胺、长春新碱、阿霉素、大剂量甲氨蝶呤、亚叶酸钙(cyclophosphamide,vincristine,doxorubicin,high-dose methotrexate,CODOX-M)/异环磷酰胺、依托泊苷、大剂量阿糖胞苷联合利妥昔单抗(ifosfamide,etoposide,high-dose cytarabine and rituximab,IVAC-R)方案治疗艾滋病(acquired immune deficiency syndrome,AIDS)相关伯基特淋巴瘤(burkitt lymphoma,BL)患者的疗效和安全性。方法本研究为一项单中心回顾性队列研究,纳入2010年12月至2022年6月期间于首都医科大学附属北京地坛医院诊断为艾滋病相关伯基特淋巴瘤患者41例,26例患者接受DA-EPOCH-R方案治疗(观察组),15例患者接受改良CODOX-M/IVAC-R方案治疗(对照组),收集患者的临床特征、实验室检查、不良反应和临床疗效,采用多变量Cox比例风险模型评估预后相关风险因素。结果41例入组患者中,97.6%为男性,中位年龄为43岁,41.5%的患者基线中位CD4^(+)细胞计数低于200个/μL。中位随访17个月,观察组患者的完全缓解(complete response,CR)率显著高于对照组(57.7%vs.33.3%),观察组患者中位总生存期(overall survival,OS)与对照组相比差异有统计学意义,分别为18.0个月和6.7个月(95%CI:5.0~16.6)(P<0.001);而观察组治疗相关的病死率却显著低于对照组(0%vs 26.7%,P<0.01)。结论DA-EPOCH-R方案治疗AIDS相关伯基特淋巴瘤较改良CODOX-M/IVAC-R方案具有更优的生存获益且安全性良好,可作为该类患者的优选化学药物治疗方案。
文摘原发性纵隔大B细胞淋巴瘤(primary mediastinal large B-cell lymphoma,PMBCL)是弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的一种特殊亚型,好发于年轻女性[1-2]。PMBCL是一种罕见的癌症,目前对复发/难治性PMBCL的治疗一般与其他复发/难治性DLBCL治疗相同,治疗方案主要包括:R-DA-EPOCH(利妥昔单抗+依托泊苷+泼尼松+长春新碱+环磷酰胺+阿霉素),DHAP(地塞米松+阿糖胞苷+顺铂),ESHAP(依托泊苷+甲基强的松+阿糖胞苷+铂剂),GDP(吉西他滨+地塞米松+顺铂),以及mini-beam(卡莫司汀+依托泊苷+阿糖胞苷+马法兰)[3-4]。
基金financially supported by the National Natural Science Foundation of China(Nos.81873450 and 82170181)the Beijing Municipal Administration of Hospitals’Youth Program(No.QMS20200201).
文摘Background: To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Waldeyer’s ring diffuse large B-cell lymphoma (WR-DLBCL) at a single institution. Methods: This retrospective study included 115 newly diagnosed patients with WR-DLBCL, of whom 68 patients received R-CHOP, and 47 patients received DA-EPOCH-R as their first-line treatment. The baseline features of the two groups were well balanced using a 1:1 propensity score matching method, and a total of 84 cases were obtained, including respective 42 cases in the R-CHOP and DA-EPOCH-R groups, for further survival and prognosis analysis. The primary objectives included progression-free survival (PFS) and overall survival (OS). Results: During a median follow-up of 45 months, there were nine (21.4%) deaths in the R-CHOP group and two (4.8%) in the DA-EPOCH-R group. Kaplan-Meier analysis showed statistically significant improvements in PFS and OS in patients with DA-EPOCH-R compared with those treated with R-CHOP (log-rank test, P = 0.025 and P = 0.035, respectively). The 2-year PFS and OS rates in the DA-EPOCH-R group were 90.1% (95% confidence interval [CI]: 81.4-99.8%) and 95.2% (95% CI: 89.0-100.0%), respectively, and 80.5% (95% CI: 69.3-93.6%) and 90.5% (95% CI: 52.8-99.8%) in the R-CHOP group. Patients without B symptoms and elevated lactate dehydrogenase levels had a higher PFS in the DA-EPOCH-R group, with P values of 0.038 (hazard ratio [HR]: 0.11;95% CI: 0.01-0.88) and 0.042 (HR: 0.19;95% CI: 0.04-0.94), respectively. There were no statistically significant differences in clinical responses and treatment-related toxicities between the two groups. Conclusion: Compared with patients received R-CHOP, those treated by DA-EPOCH-R had superior PFS, OS, and controlled toxicity in patients with WR-DLBCL.
