The Clinical Study Of The Pegylated Liposomal Doxorubicin In The Treatment Of Diffuse Large B-cell Lymphoma

Objective:In this study,the efficacy and safety of peglated liposomal doxorubicin(PLD)and epirubicin(EPI)in the treatment of diffuse large B-cell lymphoma(Diffuse large B-cell lymphoma,DLBCL)were retrospectively analyzed to evaluate the clinical value of PLD.Methods:From January 1,2014 to December 31,2018,we retrospectively analyzed the clinical data of newly diagnosed DLBCL patients who were admitted to the Department of Hematology,Ningbo Yinzhou People’s Hospital.According to the inclusion criteria,46 patients received PLD-based CDOP-like regimen(group A)and 58 untreated DLBCL patients received EPI-based CHOP-like regimen(group B).Univariate and multivariate analysis were used to analyze the risk factors affecting the prognosis of DLBCL,and the short-term efficacy,long-term survival rate and adverse reactions were compared between the two groups.Results:1.The clinical characteristics of the two groups: there was no significant difference between the two groups in age,ECOG physical status score,Ann Arbor stage,serum lactate dehydrogenase(LDH),serum β2-microglobulin(β2-MG),international prognostic index(IPI),the proportion of large mass(≥7.5cm),onset of cardiovascular disease and other baseline data.2.The short-term efficacy of the two groups(8 courses of treatment before induction chemotherapy): in group A,30 cases reached complete remission(CR)(65.20%)and 6 cases reached partial remission(PR)(13.04%).Objective remission rate(ORR)was 78.24%,34 cases in group B reached CR(58.64%),8 cases reached PR(13.82%),ORR was 72.46% ORR in group A was higher than that in group B,but there was no statistical difference.Furthermore,there was no significant difference in short-term curative effect between the two groups according to age,Ann Arbor stage,IPI score,basic heart disease and large mass(P > 0.05).3.Long-term survival of the two groups: the median follow-up of the whole group was 29(6-70)months,the 3-year disease-free survival rate(PFS)was 57.53%,and the 3-year overall survival rate(OS)was 74.61%.The 3-year PFS of group A and group B was 66.01% and 51.42%respectively,there was no statistical difference;the 3-year OS of group An and group B was76.82% and 68.91% respectively,there was also no statistical difference.4.Adverse reactions: there was no significant difference in the incidence of myelosuppression,infection,hepatorenal toxicity,gastrointestinal reaction,meridian toxicity and oral mucositis between two groups(P > 0.05).The incidence of interstitial pneumonia in group A(28.26%)was significantly higher than that in group B(3.45%).The incidence of alopecia in group A(26.09%)was significantly higher than that in group B(56.90%).The incidence of cardiotoxicity and elderly patients(> 60 years old)in group A was significantly lower than that in group B(P < 0.003,P <0.001),but there was no significant difference in cardiotoxicity between young patients(age < 60 years old)(P=0.813).5.The results of prognostic factor analysis: uivariate risk results showed that elderly,pathological subtype Non-GCB,Ann Arbor stage Ⅲ-Ⅳ,IPI score≥3,serum LDH>250IU/L,serum β2-MG>3.0mg/L,basic cardiovascular disease,large mass,short-term effect not reaching PR,bone marrow involvement and extranodal involvement≥2 were poor prognostic factors.The multivariate analysis showed that old age,IPI score≥3 and short-term curative effect not reaching PR were independent factors for poor prognosis of the patients with this disease.Conclusions:1.The short-term efficacy and long-term survival rate of CDOP-like regimen based on PLD was similar to that of CHOP-like regimen based on EPI in the treatment of newly diagnosed DLBCL.2.CDOP-like regimen can significantly reduce the incidence of alopecia;for incidence of cardiovascular diseases and elderly DLBCL patients,CDOP-like regimen can significantly reduce their cardiotoxicity,but we should pay attention to the occurrence of interstitial pneumonia.