在弥漫性大B细胞淋巴瘤治疗中，从R-CHOP方案中省略/减少长春新碱的影响。
Impact of Omission/Reduction of Vincristine From R-CHOP in Treatment of DLBCL.
作者信息
Marshall Shoko, Nishimura Noriko, Inoue Norihito, Yamauchi Hirofumi, Tsuyama Naoko, Takeuchi Kengo, Mishima Yuko, Yokoyama Masahiro, Ogasawara Toshie, Mori Naoki, Ogawa Tetsuya, Sakura Hiroshi, Terui Yasuhito
机构信息
Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan; Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan.
Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan.
出版信息
Clin Lymphoma Myeloma Leuk. 2021 Mar;21(3):162-169. doi: 10.1016/j.clml.2020.12.017. Epub 2020 Dec 23.
BACKGROUND
The R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is the standard therapy for patients with diffuse large B-cell lymphoma (DLBCL). However, vincristine is sometimes omitted or reduced owing to side effects.
MATERIALS AND METHODS
We retrospectively reviewed newly diagnosed patients with DLBCL with R-CHOP-like chemotherapy in our institute from January 2005 to February 2018 to investigate whether the omission/reduction of vincristine reduced the efficacy of the treatment. We compared the overall survival (OS) with and without the omission/reduction of vincristine from the R-CHOP regimen.
RESULTS
A total of 576 cases were reviewed, and vincristine was omitted/reduced in 50 (9%) patients. The 4-year OS with and without vincristine omission/reduction for relative dose intensity < 80%, 50%, and 25% was 70% versus 82% (P = .035), 70% versus 82% (P = .085), and 53% versus 82% (P = .0007). In a multivariate analysis, adjusting for international prognostic index risk factors, a statistically significant, poor OS was indicated in the patients with relative dose intensity < 25%.
CONCLUSIONS
Excessive dose omission/reduction of vincristine might lead to a substantial loss of efficacy of R-CHOP therapy.
背景
R-CHOP方案（利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松龙）是弥漫性大B细胞淋巴瘤（DLBCL）患者的标准治疗方案。然而，由于副作用，长春新碱有时会被省略或减量。
材料与方法
我们回顾性分析了2005年1月至2018年2月在我院接受类似R-CHOP化疗的新诊断DLBCL患者，以研究省略/减少长春新碱是否会降低治疗效果。我们比较了R-CHOP方案中省略/减少长春新碱与未省略/减少长春新碱患者的总生存期（OS）。
结果
共回顾了576例病例，50例（9%）患者省略/减少了长春新碱。相对剂量强度<80%、50%和25%时，省略/减少长春新碱与未省略/减少长春新碱患者的4年总生存率分别为70%对82%（P = .035）、70%对82%（P = .085）和53%对82%（P = .0007）。在多变量分析中，校正国际预后指数风险因素后，相对剂量强度<25%的患者总生存期具有统计学意义的较差。
结论
长春新碱剂量过度省略/减少可能会导致R-CHOP治疗效果大幅降低。
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