Combination Of Cellular Immunotherapy And Rituximab-based Regimens In Patients With Diffuse Large B Cell Lymphoma

Objective:Preclinical trials showed that CIK cells,? ? T cells and NK cells had cytotoxic activity against lymphoma,which could be enhanced by anti-CD20 antibodies.And the immune cells had synergistic killing effects.Clinical studies showed that these cells had therapeutic effect on lymphoma.The aim of this study was to investigate the effects of CIK,? ? T,NK cells-based cellular immunotherapy(CIT)in combination with R-based regimens on PFS and OS of patients with diffuse large B cell lymphoma(DLBCL).Methods:From January 2010 to September 2015,the clinical data of 67 patients with DLBCL diagnosed pathologically in our hospital and treated initially with R-based regimens were collected.According to whether CIT was used or not,the patients were divided into study group and control group.According to the number of CIT courses,the patients were divided into ? 3 courses group and> 3 courses group.The PFS and OS were compared between groups.Cox proportional hazard model was applied to analyze factors affecting PFS and OS by multivariate analysis.Results:20 patients were included in the study group with mean age of 54.25 years old,and 47 cases in the control group with mean age of 57.13 years old.Themedian follow-up time was 36 months and there was no loss of follow-up.The baselines were balanced between two groups except for B symptom.The number of patients with B symptoms in the control group was significantly more than that in the study group(c2=5.376,P=0.020).The 3-year PFS rates of the study and control group were 83.1% and 69.9%,respectively.And the3-year OS rates of the study and control group were 87.7% and 75.4%,respectively.Compared with control group,the improvement in 3-year PFS was13.2%(13-13.4)for study group,and OS rate was improved by 12.3%(12.1-12.5)after combination with CIT.In the subgroup analysis,the PFS in the > 3 courses group was significantly longer than that in the ?3 courses group,but the OS was not improved significantly(P=0.092).In multivariate analysis,elevated LDH showed a significant association with worse PFS,and elevated LDH and extranodal involvement(>1)showed significant associations with worse OS.Among the patients receiving CIT,one patient had skin rash.Conclusion:Combination of CIT and R-based regimens is based on preclinical and clinical statistics,and is well tolerated and showed a great potential to improve the PFS and OS of the patients with newly-diagnosed DLBCL.Multiple courses of CIT can significantly prolong the patient's PFS.It is worthwhile to study this combination strategy in prospective clinical studies with large sample size and longer follow-up time.