上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (6): 752-.doi: 10.3969/j.issn.1674-8115.2017.06.007

• 论著（临床研究） • 上一篇    下一篇

ICE治疗84例复发难治性弥漫大B细胞淋巴瘤的疗效及预后分析

赵冰冰 1*，张慕晨 2*，郝杰 3，刘振宇 3，熊红 1，赵维莅 2，王黎 2   

  1. 上海交通大学  医学院附属瑞金医院 1. 血液科联合病房（徐汇区中心医院），上海 200031；2. 血液科，上海 200025; 3. 血液科联合病房（北站 医院血液科），上海 200070
  • 出版日期:2017-06-28 发布日期:2017-07-05
  • 通讯作者: 王黎，电子信箱：wl wangdong@126.com
  • 作者简介:赵冰冰（1980—），女，主治医师，硕士；电子信箱：zjocclusion@126.com。张慕晨（1992—），女，博士生；电子信箱：zhangmuchen@126.com。 * 共同第一作者。
  • 基金资助:

    国家自然科学基金（81325003, 81520108003, 81670716, 81201863）；上海市杰出青年医学人才培养资助计划；上海市教育委员会高峰高原学科建设 计划（20152206，20152208）；上海市科学技术委员会项目（14430723400, 14140903100, 16JC1405800）；静安区卫生科研课题（2016MS11）；徐汇区中心医院 院级科研课题（2014XHYY-04）；上海交通大学SMC- 晨星青年学者奖励计划

Efficacy and prognostic analysis of ICE regimen for 84 patients with relapsed/refractory diffuse large B-cell lymphoma

ZHAO Bing-bing1*, ZHANG Mu-chen2*, HAO Jie3, LIU Zhen-yu3, XIONG Hong1, ZHAO Wei-li2, WANG Li2   

  1. 1. Associated Hematological Department of Ruijin Hospital (Central Hospital of Xuhui District), Shanghai 200031, China; 2. Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200025, China; 3. Department of Hematology, Beizhan Hospital, Shanghai 200070, China
  • Online:2017-06-28 Published:2017-07-05
  • Supported by:

    National Natural Science Foundation of China, 81325003, 81520108003, 81670716, 81201863; Shanghai Excellent Young Medical Talents Training Funding Program; Shanghai Municipal Education Commission–Gaofeng Clinical Medicine Grant Support, 20152206, 20152208; Project of Shanghai Science and Technology Committee, 14430723400, 14140903100, 16JC1405800; Jing-an District Health Research Project, 2016MS11; Xuhui District Central Hospital Research Project, 2014XHYY-04; SMC-Morningstar Young Scholars Program

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摘要：

目的 · 研究 ICE ( 异环磷酰胺、卡铂、依托泊苷 ) 方案治疗复发难治性弥漫大 B 细胞淋巴瘤（DLBCL）患者的有效性及相关 预后因素。方法 · 回顾性分析 2004 年 7 月—2016 年 6 月收治的 84 例初发进展期及复发难治性 DLBCL 患者的临床资料，给予 ICE 方 案化疗，采用 Kaplan-Meier 方法计算总生存期，并采用 Cox 回归方法进行多因素分析。结果 · 84 例患者中 26 例达完全缓解，11 例达 部分缓解，客观缓解率为44.0%；获得缓解所需的化疗疗程的中位数为3 个（1 ～ 6 个）。 1 年总体生存率为 49.5%，2 年总体生存率 为 30.0%，中位生存期为 12.2 个月。单因素分析显示早期复发或进展（P=0.041）、 IPI 中高危 / 高危（P=0.024）及 NCCN-IPI 中高危 / 高危（P=0.002）是影响患者生存的不良因素，化疗后缓解与延长患者生存显著相关（P=0.000）；多因素分析提示 NCCN-IPI 中高危 / 高危为影响患者生存的独立危险因素，化疗后缓解为延长患者生存的独立预后指标。结论 · ICE 方案可作为复发难治性 DLBCL 患者 的有效挽救性治疗方案。

关键词: 复发难治性弥漫大 B 细胞淋巴瘤, 预后, 挽救治疗, ICE 方案

Abstract:

 Objective · To evaluate the efficacy and prognostic factors of ifosfamide-cisplatin-etoposide (ICE) chemotherapy as salvage regimen for patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL).  Methods · A retrospective analysis was performed on 84 relapsed/refractory DLBCL patients who were treated with ICE salvage regimen at Ruijin Hospital (Shanghai Jiao Tong University School of Medicine, China) from July 2004 to June 2016. Overall survival (OS) was analyzed by Kaplan-Meier method and multivariate Cox proportional hazards models.  Results · Of the 84 patients who were treated with ICE regimen, 37 (44.0%) patients had responses, including 26 (31.0%) achieving complete remission. The median number of cycles per patient was 3 (range 1-6 cycles). The 1-year and 2-year OS rates were 49.5% and 30.0%, respectively. The median OS time was 12.2 months. On univariate analysis, patients with early progression/recurrence (P=0.041) and a high-intermediate/high risk according to the international prognostic index (IPI) (P=0.024) and NCCN-IPI (P=0.002) had poorer outcomes. While improved outcome was found in patients in complete remission after chemotherapy (P=0.000). The multivariate analysis revealed that the intermediate-high/high risk according to NCCN-IPI was an independent risk factor, and remission after chemotherapy was an independent prognostic factor for prolonging survival.  Conclusion · The ICE regimen can be used as an effective salvage therapy for patients with relapsed/refractory DLBCL.

Key words: relapsed/refractory diffuse large B-cell lymphoma, prognosis, salvage regimens, ICE chemotherapy