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Title: [A Retrospective Study of R±DHAX Regimen versus R-CHOP Regimen First-Line Treatment of Elderly Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma].
Author: Wei WP, Yu XQ, Wang LX, Zhang S, Fei XM.
Journal: Zhongguo Shi Yan Xue Ye Xue Za Zhi; 2024 Jun; 32(3):718-722. PubMed ID: 38926958.
Abstract:
OBJECTIVE: To investigate the clinical efficacy and prognosis of Rituximab combined with DHAX and CHOP regimen in the first-line treatment of elderly patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). METHODS: A total of 36 elderly patients with DLBCL who were admitted and treated with 3 of more courses of treatment from August 2011 to August 2021 were retrospectively analyzed, and they were divided into rituximab±DHAX (R±DHAX) regimen group (18 cases) and rituximab±CHOP (R-CHOP) regimen group (18 cases) according to the treatment plan, and clinical features, efficacy and survival of the patients were observed. RESULTS: Compared with R-CHOP group, patients of the R±DHAX group were older, and had worse performance status and higher IPI score, the differences between two groups in age, ECOG score and IPI score were statistically significant ( P =0.005 P =0.018, P =0.035), but there were no significant differences beween two groups in gender, whether there were B symptoms, whether LDH was elevated, whether there was extranodal involvement, cell origin, bone marrow infiltration, and whether rituximab was combined ( P =0.738, P =1, P =0.315, P =0.305, P =0.413, P =0.177, P =0.711, P =0.229). The efficacy could be evaluated in 36 cases, including CR 14 (38.9%), PR 17 (47.2%), PD 5 (13.9%), and ORR of 86.1% (31/36). There were no statistically significant differences in CR［(27.8%（5/18） vs 50.0%（9/18）; P >0.05］ and PR ［44.4%（8/18） vs 50.0%（9/18）; P >0.05］ of R±DHAX group and R-CHOP group, there was statistically significant difference in ORR［72.2%（13/18） vs 100.0%（18/18）; P =0.045］ between two groups. The 1-year OS of R±DHAX group and R-CHOP group was (38.9±11.5%)% and (94.4±7.4%)%, respectively, 2-year OS was (16.7±8.8)% and (72.2±10.6)%, respectively, and the differences between two groups were statistically significant ( P =0.001, P =0.002). The median survival time in the R±DHAX group was 11 months(95%CI :8.9-13.1), and the median survival time in the R-CHOP group was not reached, and there was a statistically significant difference between the groups (P < 0.001). CONCLUSION: For elderly DLBCL patients, R±DHAX may not be superior to R-CHOP in OS, and ECOG score, IPI score and age may affect the survival of elderly DLBCL patients. However, R±DHAX regimen is safe, tolerable and has a certain efficacy, which can be used as one of the clinical treatment options for elderly DLBCL. 题目: 利妥昔单抗联合DHAX方案与CHOP方案一线治疗老年初诊弥漫大B细胞淋巴瘤的回顾性研究. 目的: 探讨R±DHAX方案与R-CHOP方案一线治疗老年初诊弥漫大B细胞淋巴瘤（DLBCL）患者的临床疗效及预后。. 方法: 回顾性分析江苏大学附属医院血液科2011年8月—2021年8月收治并至少完成3疗程的36例老年DLBCL患者，根据治疗方案分为利妥昔单抗±DHAX（R±DHAX）方案组（18例）和利妥昔单抗联合CHOP（R-CHOP）方案组（18例），观察患者的临床特征、疗效及生存。. 结果: 与R-CHOP组比较，R±DHAX组患者更高龄、体能状态更差及IPI评分更高，在年龄、ECOG评分、IPI评分上两组间差异有统计学意义(P =0.005，P =0.018，P =0.035)，而在性别、有无B症状、LDH是否升高、有无结外累及、细胞来源、有无骨髓浸润、是否联合使用利妥昔单抗上两组间差异均无统计学意义(P =0.738，P =1，P =0.315，P =0.305，P =0.413，P =0.177，P =0.711，P =0.229)。36例患者均可评价疗效，其中CR 14例（38.9%）、PR 17例（47.2%）、PD 5例（13.9%），ORR为86.1%（31/36）。R±DHAX组和R-CHOP组CR［(27.8%（5/18）对50.0%（9/18）］、PR［44.4%（8/18）对50.0%（9/18）］差异无统计学意义，但ORR［72.2%（13/18）对100.0%（18/18）］差异有统计学意义(P =0.045)。R±DHAX组和R-CHOP组1年OS率分别为（38.9±11.5）%和（94.4±7.4）%，2年OS率分别为（16.7±8.8）%和（72.2±10.6）%，组间比较差异有统计学意义（P =0.001，P =0.002）。R±DHAX组中位生存时间11个月（95%CI ：8.9-13.1），R-CHOP组中位生存时间未达到，组间存在统计学差异(P <0.001)。. 结论: 对于老年DLBCL患者，在OS方面R±DHAX方案可能不优于R-CHOP方案，且ECOG评分、IPI评分、年龄可能影响老年DLBCL患者生存。但R±DHAX方案安全、可耐受且具有一定疗效，可作为临床上老年DLBCL治疗选择之一。.

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