Aggressive lymphoma: improving treatment outcome with rituximab
Aggressive lymphoma: improving treatment outcome with rituximab
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DOI：
10.1097/00001813-200211002-00007
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发表时间：
2002-11-01
影响因子：
2.3
通讯作者：
Zinzani, PL
中科院分区：
文献类型：
--
作者：
Coiffier, B;Pfreundschuh, M;Zinzani, PL
侵袭性淋巴瘤患者的标准治疗是环磷酰胺、阿霉素、长春新碱和泼尼松（CHOP）化疗，60%以上的患者完全缓解，但只有约40-50%的患者治愈。与CHOP相比，更积极和/或剂量强化的化疗方案未能提供显着的生存优势，并且可能具有更高的毒性。Rituximab是一种针对CD20抗原的嵌合单克隆抗体，作为侵袭性淋巴瘤的单药治疗有效，并且在11期试验中与化疗联合使用显示出高反应率。一项随机前瞻性试验的中期分析比较了利妥昔单抗联合CHOP与单独CHOP治疗未经治疗的弥漫性大b细胞淋巴瘤的老年患者，结果显示，利妥昔单抗联合CHOP治疗的有效率和生存率明显优于单独CHOP治疗。这些结果表明，在侵袭性淋巴瘤中，CHOP治疗20多年来首次显著改善了总生存率。与单独使用CHOP相比，添加利妥昔单抗与显著的额外毒性无关。正在进行的研究正在确定是否利妥昔单抗加CHOP在年轻患者群体中有生存获益。利妥昔单抗联合化疗也被评估为首次化疗后复发的患者的补救性治疗。在一项对50例难治性或复发性侵袭性淋巴瘤患者的初步分析中，利妥昔单抗联合依托泊苷、强的松、新碱、环磷酰胺和阿霉素（EPOCH）化疗在作为唯一的挽救性治疗和自体干细胞移植前的诱导治疗时显示出良好的结果，同样没有显著的额外毒性。[(C) 2002 Lippincott Williams Wilkins]
The standard therapy for patients with aggressive lymphoma is cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy, which achieves a complete response in more than 60% of patients but is curative in only about 40-50%. More aggressive and/or dose-intensified chemotherapy regimens have failed to provide significant survival advantages compared with CHOP, and may have higher toxicity. Rituximab, a chimeric monoclonal antibody to the CD20 antigen, is effective as monotherapy in aggressive lymphoma and in combination with chemotherapy has demonstrated high response rates in phase 11 trials. A scheduled interim analysis of a randomized, prospective trial comparing rituximab plus CHOP with CHOP alone in elderly patients with untreated diffuse large B-cell lymphoma has shown significantly better response rates and survival with rituximab plus CHOP compared with CHOP alone. These results represent the first significant improvement in overall survival over CHOP in aggressive lymphoma for over 20 years. The addition of rituximab was not associated with significant additional toxicity over that seen with CHOP alone. Ongoing studies are underway to establish whether the survival benefit of rituximab plus CHOP is seen in younger patient populations. Rituximab in combination with chemotherapy is also being evaluated as salvage treatment for patients who relapse after initial chemotherapy. In a preliminary analysis of a study in 50 patients with refractory or relapsed aggressive lymphoma, rituximab plus etoposide, prednisone, vin-cristine, cyclophosphamide and doxorubicin (EPOCH) chemotherapy has demonstrated promising results when used as sole salvage therapy and as an induction therapy prior to autologous stem-cell transplantation, again without significant additional toxicity. [(C) 2002 Lippincott Williams Wilkins]