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利妥昔单抗联合常规化疗方案治疗弥漫性大B细胞淋巴瘤患者的疗效及复发影响因素

Efficacy of rituximab combined with conventional chemotherapy in treating patients with diffuse large B-cell lymphoma and influencing factors of recurrence

    摘要
  • 摘要:
      目的  探讨利妥昔单抗联合常规化疗方案治疗弥漫性大B细胞淋巴瘤(DLBCL)的临床疗效，分析患者复发的影响因素。
      方法  回顾性分析2018年1月—2021年1月收治的104例DLBCL患者的临床资料，患者均接受利妥昔单抗联合常规化疗。观察利妥昔单抗联合常规化疗方案的治疗效果; 根据随访结果将患者分为复发组和缓解组，采用多因素Logistic回归模型分析复发的影响因素。
      结果  104例DLBCL患者中，疗效达到完全缓解者65例(62.50%), 部分缓解者16例(15.38%), 稳定者6例(5.77%), 复发或进展者17例(16.35%), 总有效率为77.88%(81/104)。随访3个月时，死亡21例，难治或复发37例，病情缓解46例。复发组B症状阳性率、中性粒细胞与淋巴细胞计数比值(NLR)、β2-微球蛋白(β2-MG)、红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)、血清乳酸脱氢酶(LDH)水平高于缓解组，血红蛋白(Hb)、淋巴细胞与单核细胞计数比值(LMR)、血浆白蛋白(ALB)、高密度脂蛋白(HDL)水平低于缓解组，差异均有统计学意义(P < 0.01)。多因素Logistic回归分析显示, B症状、Hb、NLR、LMR、β2-MG、ESR、hs-CRP、ALB、LDH、HDL等均为DLBCL复发的影响因素(P < 0.05)。
      结论  利妥昔单抗联合常规化疗方案治疗DLBCL可以取得一定的临床疗效，但仍存在较高的复发率，而B症状阳性、淋巴细胞、炎症状态、机体营养状态是影响DLBCL复发的风险因素。

     

    Abstract:
      Objective  To explore the clinical efficacy of rituximab combined with conventional chemotherapy in treating patients with diffuse large B-cell lymphoma (DLBCL), and analyze the influencing factors of recurrence.
      Methods  Clinical materials of 104 DLBCL patients from January 2018 to January 2021 were retrospectively analyzed, and all of them were conducted with rituximab combined with conventional chemotherapy. Therapeutic effect of rituximab combined with conventional chemotherapy was observed; according to the follow-up results, the patients were divided into recurrence group and remission group, and the influencing factors of recurrence were analyzed by multivariate Logistic regression model.
      Results  Of 104 patients with DLBCL, there were 65 cases (62.50%) with complete remission, 16 cases (15.38%) with partial remission, 6 cases (5.77%) with stable disease and 17 cases (16.35%) with relapsed or progressive disease, and the total effective rate was 77.88% (81/104). At 3 months of follow-up, 21 cases died, 37 cases were refractory or relapsed, and 46 cases were relieved. The positive rate of B symptoms, the neutrophil-to-lymphocyte ratio (NLR) and levels of β2-microglobulin(β2-MG), erythrocyte sedimentation rate (ESR), high-sensitivity C reactive protein (hs-CRP) and serum lactate dehydrogenase (LDH) in the recurrence group were significantly higher than those in the remission group, while the hemoglobin (HB), lymphocyte-to-monocyte ratio (LMR), plasma albumin (ALB) and high-density lipoprotein (HDL) were significantly lower than those in the remission group (P < 0.01). Multivariate Logistic regression analysis showed that B symptoms, Hb, NLR, LMR, β2-MG, ESR, hs-CRP, ALB, LDH and HDL were the influencing factors of recurrence of DLBCL (P < 0.05).
      Conclusion  Rituximab combined with conventional chemotherapy can achieve a certain clinical efficacy in the treatment of patients with DLBCL, but there is still a high recurrence rate, and positive B symptoms, lymphocytes, inflammatory status and nutritional status are risk factors affecting the recurrence of DLBCL.

     

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