DA-EPOCH-R improves the outcome over that of R-CHOP regimen for DLBCL patients below 60years, GCB phenotype, and those with high-risk IPI, but not for double expressor lymphoma
DA-EPOCH-R improves the outcome over that of R-CHOP regimen for DLBCL patients below 60years, GCB phenotype, and those with high-risk IPI, but not for double expressor lymphoma
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对于60岁以下、GCB表型和高危IPI患者的DLBCL患者，DA-EPOCH-R比R-CHOP方案改善了结果，但对双表达淋巴瘤患者没有改善
DOI：
10.1007/s00432-018-2771-9
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发表时间：
2019
影响因子：
3.6
通讯作者：
Xu Wei
中科院分区：
文献类型：
--
作者：
Zhang Xin-Yu;Liang Jin-Hua;Wang Li;Zhu Hua-Yuan;Wu Wei;Cao Lei;Fan Lei;Li Jian-Yong;Xu Wei
目的回顾性比较DA-EPOCH-R和R-CHOP方案治疗弥漫性大B细胞淋巴瘤（DLBCL）的疗效。方法252例患者接受R-CHOP方案治疗，146例患者接受DA-EPOCH-R方案治疗。结果R-CHOP方案治疗DLBCL的总有效率为162 R-CHOP方案和DA-EPOCH-R方案分别有43例（17.1%）和14例（9.6%）获得部分缓解。中位随访48个月后，DA-EPOCH-R组的无进展生存期（PFS）较好，但DA-EPOCH-R组的总生存期（OS）与R-CHOP组相比无明显改善（PFS P= 0.015，OS P= 0.19）。然而，根据细胞来源、国际预后指数（IPI）和年龄进行的亚组分析显示，在具有生发中心B细胞样（GCB）表型的患者中，DA-EPOCH-R方案的PFS和OS显著优于R-CHOP方案（PFS P= 0.002，OS P= 0.007）、高IPI（PFS P= 0.002; OS P= 0.03）和年龄较小（PFS P= 0.002，OS P= 0.045）。我们还比较了双表达淋巴瘤（DEL）患者的两种方案。DEL患者的预后明显差于非DEL患者（P< 0.001，P< 0.001），但DA-EPOCH-R方案可能无法克服其不良预后（P= 0.47，P= 0.79）。
PurposeThis study was to compare DA-EPOCH-R and R-CHOP regimen as first-line therapy in diffuse large B cell lymphoma (DLBCL) patients, retrospectively.MethodsA total of 252 cases treated with R-CHOP and 146 cases who received DA-EPOCH-R were enrolled into this study.ResultsOverall, 162 (64.3%) and 105 patients (71.9%) achieved complete remission, 43 (17.1%) and 14 patients (9.6%) achieved partial remission following R-CHOP and DA-EPOCH-R regimen, respectively. After a median follow-up of 48 months, better progression-free survival (PFS) was seen in DA-EPOCH-R group, but no better overall survival (OS) was found in patients treated with DA-EPOCH-R compared to R-CHOP (P= 0.015 for PFS,P= 0.19 for OS). However, subgroup analysis according to cell of origin, international prognostic index (IPI), and age showed DA-EPOCH-R resulted in significantly better PFS and OS than R-CHOP regimen in patients with germinal center B-cell-like (GCB) phenotype (P= 0.002 for PFS,P= 0.007 for OS), high IPI (P= 0.002 for PFS;P= 0.03 for OS), and with a younger age (P= 0.002 for PFS,P= 0.045 for OS). We also compared two regimens in patients with double expressor lymphoma (DEL). The prognosis of DEL patients was significantly worse than non-DEL patients (P< 0.001 for PFS,P< 0.001 for OS), but DA-EPOCH-R regimen may not overcome the poor prognosis (P= 0.47 for PFS,P= 0.79 for OS).ConclusionGCB DLBCL, younger patients, and high-risk patients, but not DEL patients, may benefit from continuous-infusion DA-EPOCH-R regimen.