Analysis Of Clinical Effect Of R-EPOCD Combined With PEG-rhG-CSF In First-line Treatment Of Double-expressor Lymphoma

Purposes:To explore the efficacy and adverse reactions of R-EPOCD(rituximab,etoposide,prednisone,vincristine,cyclophosphamide,doxorubicin liposome)regimen in the treatment of double-expressor lymphoma(DEL).To explore whether the application of PEGylated recombinant human granulocyte stimulating factor(PEG-rhG-CSF)or ordinary recombinant granulocyte stimulating factor(rhG-CSF)is more advantageous in treating neutropenia reduced by R-EPOCD regimen.Methods:Clinical data of a total of 17 newly-treated DEL patients who received R-EPOCD chemotherapy in the Department of Lymphoma,Affiliated Hospital of Qingdao University.We retrospectively analyzed 17 cases of short-term efficacy and the incidence of adverse reactions to chemotherapy.According to the actual application of stimulating factors in the first cycle of patients,they were divided into the PEG-rhG-CSF group and the rhG-CSF group.We compared the hospitalization costs,average hospitalization days,days of application of carbapenic antibiotics,the incidence of neutropenia with fever(FN),the incidence and duration of IV neutropenia,and unplanned readmission rates and changes in the absolute neutrophil count(ANC)between two groups.We use SPSS23.0software for statistical analysis.The comparison between the two groups was performed using thec~2 test or FISHER exact probability method.The Mann-Whitney U test was used to compare the data difference between two groups in terms of hospitalization costs and hospitalization days.K-M method was used to draw survival analysis curve,and Log-rank was used to perform single factor analysis.Inspection level ?=0.05.P value<0.05 was considered statistically significant.Results:A total of 13 patients could be evaluated for efficacy.The complete remission rate(CR)of DEL patients treated with R-EPOCD regimen was 84.6%(11/13).The median follow-up time was 11 months.The overall survival(OS)and progression-free survival(PFS)of the patients were 91.7%and 79.1%,respectively.The hematological adverse reactions in patients with DEL were mainly I/II degree anemia,III/IV degree white blood cell count decrease and III/IV degree neutropenia,the incidence rate was 57.7%(56/97)and 47.4%(46/46)and 45.4%(44/97),respectively.Non-hematological adverse reactions were mainly constipation(16.5%)and abnormal ECG(29.9%).The treatment-related mortality rate was 0.The hospitalization costs,hospitalization days and days of carbapenem antibiotic use in the PEG-rhG-CSF group were significantly lower than those in the rhG-CSF group(Z=3.003,P=0.003;Z=6.444,P=0.044;Z=7.667,P=0.034).There was a significant difference in the incidence of FN between the two groups(?~2=7.906,P=0.048).The incidence of IV neutropenia in the PEG-rhG-CSF group was 28.6%,which was lower than 71.4%in the rhG-CSF group,but the difference was not statistically significant(?2=2.571,P=0.286).The average duration of ANC<0.5×10~9/L after chemotherapy was only 2 days in the PEG-rhG-CSF group,and 4.6±2.1days in the rhG-CSF group.The ANC began to decline in the PEG-rhG-CSF group at(6.4±0.9)days after the end of chemotherapy.The lowest value of ANC decline occurred at(6.7±0.6)days after the end of chemotherapy.The lowest value of ANC was(1.4±1.2)×10~9/l.It takes 2 days to increase from the lowest value to 1.0×109/l.The decrease of ANC in the rhG-CSF group generally began at(5.7±2.5)days after the end of chemotherapy.The lowest value of ANC occurred at(6.7±2.0)days after the end of chemotherapy.The minimum value of ANC was(0.3±0.6)×109/l.It takes(4.5±2.1)days for the lowest value to rise to 1.0×10~9/L.Conclusions and significance:1.After using R-EPOCD treatment,the CR rate of double-expressor lymphoma increases,which may improve the poor prognosis of DEL when the sample size is enlarged,but random control,prospective research,and long-term follow-up are still needed to confirm;2.The R-EPOCD regimen is relatively safe on the basis of PEG-rhG-CSF support therapy,and adverse reactions can be tolerated;3.Prophylactic use of PEG-rhG-CSF can reduce medical costs,shorten the average hospital stay,reduce the incidence of FN,reduce the duration of bone marrow suppression and the number of days of advanced antibiotics,which is worthy of clinical application.