背景弥漫性大B细胞淋巴瘤(DLBCL)是非霍奇金淋巴瘤的最常见亚型,其5年生存率为60%-70%,由R-CHOP组合组成的化学免疫疗法(利妥昔单抗,环磷酰胺,长春新碱,阿霉素,和泼尼松),复发/难治率为20-50%。HDT-ASCT的挽救疗法是复发性/难治性疾病患者的首选疗法,成功率为50%-60%。对首次抢救方案无反应或首次抢救方案后复发的患者,有或没有大剂量化疗(HDT)-自体干细胞移植(ASCT),总体反应和生存率较差,应提供新疗法。我们研究的目的是评估对第二次救助的反应,在资源有限的情况下,有或没有HDT-ASCT的基于吉西他滨的治疗。材料和方法这是一项回顾性研究,包括55名年龄>18岁的患者,诊断为DLBCL并接受以吉西他滨为基础的二次挽救化疗。结果中位年龄34岁,只有1例患者的无进展生存期(PFS)>12个月,ORR为27%至2个周期的吉西他滨联合用药,两年PFS和OS分别为9.6%和34%,分别,平均PFS和OS分别为4个月和13个月,分别。结论DLBCL患者,一线和首次挽救化疗难以治疗,应考虑新疗法或选择姑息治疗,而不是第二次挽救化疗和HDT-ASCT,这导致整体反应差和显著的毒性。
Background Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin\'s lymphoma with a five-year survival of 60%-70% with chemoimmunotherapy consisting of the R-CHOP combination (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone), with a relapse/refractory rate of 20-50%. Salvage therapy with HDT-ASCT is the treatment of choice for patients with relapsed/refractory disease with a success rate of 50%-60%. Patients who do not respond to the first salvage regimen or who relapsed after the first salvage regimen, with or without high-dose chemotherapy (HDT)-autologous stem cell transplantation (ASCT), have poor overall responses and survival and should be offered novel therapies. The objective of our
study was to evaluate responses to second salvage, gemcitabine-based therapy with or without HDT-ASCT in a resource-limited setting. Materials and methods This was a retrospective
study, including 55 patients aged >18 years, diagnosed with DLBCL and having received gemcitabine-based second salvage chemotherapy. Results The median age was 34 years, only one patient achieved progression-free survival (PFS) of >12 months with ORR of 27% to two cycles of gemcitabine-based combination, two years PFS and OS of 9.6% and 34%, respectively, and a median PFS and OS of four months and 13 months, respectively. Conclusion DLBCL patients, refractory to first-line and first salvage chemotherapy, should be considered for novel therapies or opt for palliative care rather than second salvage chemotherapy and HDT-ASCT, which results in poor overall response and significant toxicities.