| Background and Objective:Diffuse large B-cell lymphoma （DLBCL） is the most frequent subtype ofnon-Hodgkin’s lymphoma and responding well to chemotherapy.The CHOP regimenis used to be the standard of care for patients with DLBCL, but it’s cure rates is only30to35percents, with five-year overall survival rate (OS) of30-40percent. Theaddition of rituximab to CHOP has gradually take the place of the traditional CHOPregimen to be the first-line treatment for patients with DLBCL at present.Here weanalyzes retrospectively the efficacy and safety of rituximab plus chemotherapy andchemotherapy alone regimen on patients with newly diagnosed DLBCL in ourhospital.Methods:Clinical data were retrospectively analyzed in patients with newly diagnosedDLBCL from Jan,1,2008to Dec,31,2012in Fujian Medical University UnionHospital. A total of144patients were enrolled and non-randomly assigned torituximab plus chemotherapy（R-CHOP like,n=99) and chemotherapy alone（CHOPlike,n=45) group. They were treated with R-CHOP or CHOP every three weeks forat least four cycles. Efficacy and adverse effect between two groups were comparedbased on regular systemic evaluation. In addition, the efficacy between two groupswas compared after stratifying by different age, risk scoring, pathological type,thepositive percent of Ki-67and BCL-2positivity.Results:1.Inter-group short-term efficacy: In R-CHOP like group,66.7%(66/99) patientsreached complete remission(CR),23.2%(23/99) reached partial remission(PR), 1.0%(1/99) had stable disease(SD), and9.1%(9/99) had progressive disease(PD). Theoverall response rates were89.9%（89/99）.In CHOP like group,44.4%(22/45) patientsreached CR,40.0%(18/45) reached PR, and15.2%(5/45) had PD, the overall responserates were84.8%（40/45）. Two groups showed no significant difference in overallresponse rates (P=0.070),while the CR rates(P=0.043) were significantly improvedin R-CHOP like group.2.Inter-group long-term efficacy: Overall response rate(OS) at one-year in twogroup were93.8%and83.5%, OS at three-year in two group were82.1%and60.7%.Progression free survival(PFS) at one-year in two group were85.8%and72.2%,PFS at three-year in two group were69.6%and57.9%, Patients treated with R-CHOPlike regimen had significantly longer OS （P=0.041）and PFS（P=0.046）than thosetreated with CHOP like regimen.3.Stratification analysis of inter-group showed that patients treated with R-CHOPlike regimen displayed a significantly better CR rates than those treatedwith CHOPlike regimen in the60year’s old or younger group (P=0.041),non-GCB typegroup(P=0.012) and BCL-2positive group (P=0.020).Moreover, OS and PFS wassignificantly improved for patients treated with R-CHOP like regimen in the60year’s old or younger group(P=0.004、0.007) and GCB type group (P=0.025、0.004).The PFS has a extension tendency (P=0.059) for patients treated with R-CHOP like regimen in high intermediate risk/high risk group divided accordingto international prognostic index.The OS and PFS of patients with GCB typeand non-GCB type in R-CHOP like group had no significant difference(P=0.436and0.096).4.The hematological adverse reactions (P=0.826) and non-hematologicaltoxicities(P=0.784) were similar between both groups.Conclusion:The addition of rituximab to the chemotherapy significantly increased theCR rate, OS and PFS in patientswith DLBCL, especially for younger patients.The CR rates were significantly improved for patients with non-GCB type orBCL-2positive that treated with rituximab plus chemotherapy. Patients with GCB type treated with rituximab plus chemotherapy had longer OS and PFS thanthose treated with chemotherapy alone. Rituximab plus chemotherapy also couldreduce the unfavorable prognostic effect of non-GCB type. Rituximab pluschemotherapy improved the efficacy without a clinical significant increase inadverseeffects, could be considered as a first-line treatment of DLBCL with reliableclinical efficacy and well tolerance. |
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