Study On Rituximab Plus Chemotherpay Onpatients With Diffuse Large B-cell Lymphoma

Background: The morbidity of the diffuse large B-cell lymphoma is higher thanother’s disease in NHL, CHOP regimen is the standard treatment for patients withdiffuse large B-cell, but the single chemotherapy is not efficient. Rituximab, ananti-CD20monoclonal antibody is effective in treating diffuse large B-cell lymphomawith CD20(+).This study is conducted to compare the efficacy and toxicity of rituximabplus CHOP(R-CHOP) regimen and CHOP regimen alone on newly diagnosed patientswith diffuse large B-cell lymphomaand analyze their toxicities. The purpose is to probethe factors influencing curative effect and the current treatment of diffuse B celllymphoma with rituximab plus chemotherapy in this region.Method:The information of116cases newly diagnosed patients with diffuse largeB-cell lymphoma from jan-2005to dec-2011is summarized by the research method ofnon-concurrent control retrospectively in our hospital.52cases receive CHOPcyclophosphamide+adriamycin+vincristine+prednisone） plus rituximab(375mg/m2,intravenous infusion1day before the weekly chemotherapy)4～6cycles,64casesreceive CHOP alone with4～6cycles. Eeach cycles last3weeks.All cases are evaluatedafter4th to6th cycles about efficacy and toxicity.Results:With a mendian follow-up visited of36moths(3～76moths),The totalresponse rate in R-CHOP group is75%,among which complete remission is seen in18patients and partial remission is seen in21patients;while the total response rate inCHOP group is53.1%,among which complete remission is seen in10patients andpartial remission is seen in24patients. The therapeutic efficacy issignificantly better inR-CHOP group than in CHOP group (P=0.021).The1-year progression-freely rates aresignificantly higher in R-CHOP group than in CHOP group (63.46%vs42.18%，P<0.05).The1～3-year overall survival rates are higher in R-CHOP group than in CHOP group(82.69%、75%、55.76%vs64.06%、60.93%、48.43%),but no statistical differencescan be seen in2～3-year overall survival rates between two groups. PFS curve and OScurve of the R-CHOP and CHOP group have significant difference. It shows that theR-CHOP group is better than the CHOP group.Subgroup analysis shows that116cases is divided into GCB group (germinalcenter type) of46cases and Non-GCB group (non-germinal centre type) of70cases,among which there are CR8cases and PR18cases in GCB group with the RR rate56.52%and there are CR20cases and PR27cases in Non-GCB group with the RR rate67.14%. There is no significant difference between both groups (P=0.326). The1yearprogression-free survival rates of GCB group and Non-GCB group are56.52%and48.57%respectively. The1year PFS rate of GCB group is higher than the Non-GCBgroup, but the difference is not significant (P=0.450); there is no significant differencebetween the PFS curves of both groups (P=0.432), but there is significant differencebetween the OS curves of both groups (p=0.03) and the GCB group is better than theNon-GCB group.Another subgroup analysis is to stratify and group all the patients according to thedegree of risk and the comparative results show that in the low-risk and mediumlow-risk groups, the CR, PR and RR rates of the rituximabmonoclonal antibody pluschemotherapy compared with the chemotherapy are41.03%、30.77%、71.79%VS16.67%、38.89%、55.56%（P=0.132）respectively, and there is significant differencebetween the OS curves of both groups; and in the medium high-risk and high-riskgroups, the CR, PR and RR rates of the rituximabmonoclonal antibody combined withchemotherapy compared with the chemotherapy are15.38%、69.23%、84.62%、VS10%、30%、40%（P=0.039）respectively and there is significant difference between theOS curves of both groups.The main clinically relevant toxicity of both groups are hematological adverse ofbone marrow depression and gastrointestinal reaction, etc, and the adverse effectincidence rates of III、IVgrade of both groups are similar. In R-CHOP group, there are4cases of allergic reactions, but are all relatively minor with no affect on the treatment.Conclusions:Rituximab plus CHOP regimen increases the therapeutic efficacy ofCHOP regimen on newly diagnosed patients with diffuse large B-cell lymphoma withCD20(+),especially in medium high-risk and high-risk patient group. Non-GCB is onetype of the poor prognosis factors. The application of rituximab plus CHOPchemotherapy reduces the prognosis disparity between GCB type and no-GCB type. And the application doesn’t increase the occurrence of chemotherapy-related adverseevents concurrently.