| Objective:To compare the efficacy and adverse reactions among bendamustine, GEMOX and ICE in patients with relapsed or refractory B-cell indolent non-Hodgkin lymphoma(B-i NHL), and to evaluate the prognostic factors of B-i NHL.Methods:1. 95 patients with B-i NHL from Tianjin Medical University Institute and Hospital were retrospectively recruited from 2010.1.1 to 2013.12.31. They were divided into three groups according to regimens, 33 patients in group A of bendamustine, 32 patients in group B of GEMOX(gemcitabine and oxaliplatin) and30 patients in group C of ICE(ifosfamide, carboplatin and etoposide). All patients were subjected to 4-8 cycles therapy. The response rate was evaluated by the International Workshop NHL Response Criteria published by Cheson every 2 cycles.The PFS and OS were followed up and analyzed. The recent curative effects were analyzed by the chi-squared test. Using the Kaplan-Meier to construct survival curves and the log-rank test to compare PFS among three groups.2. Analyzing the relationship between the clinical characteristics and efficacies of the whole group, and then revealed the factors predictive of the outcomes.Results:1. Comparision among group A, B and C(1)In bendamustine group, 10 cases achieved a complete remission(CR), 15 cases partial remission(PR), 5 cases stable disease(SD), 3 cases progressive disease(PD), and overall response rate(ORR, CR+PR) was 78.5%. In GEMOX group,7 had CR, 13 had PR, 8 had SD, 4 had PD, ORR was 62.5%. In ICE group, ORR was67.3%, with 6 patients CR, 13 patients PR, 6 patients SD, 5 patients PD.Bendamustine group had a more favorable ORR, but with no statistical difference(P=0.444).(2)The median PFS of group A, B and C was 8.9, 7.3 and 7.4 months separately.Analysis had statistical differences between group A and B, A and C(P=0.020, 0.033).(3)The hemoglobin decrease rates in three groups were 9.1%, 59.4% and 46.7%,the differences were statistically significant between group A and B, A and C(P=0.000,0.001). Thrombocytopenia incidences were 33.3%, 59.4%, 46.7% in group A, B and C. It was statistically different between group A and B(P=0.035). As to peripheral sensory neuropathy, no cases appeared in bendamustine group, and GEMOX group had a higher incidence than ICE group(31.3% vs 10.0%, P=0.040). Hemorrhagic cystitis was observed in 1 patient only in ICE group. The rest adverse reactions such as liver dysfunction and fatigue had no statistically significance among three groups.2. Analysis of prognosis(1)The elevated serum LDH of 33 patients and increased β2-MG of 34 patients remarkably decreased after therapy compared with pre-treament(364+90U/L vs.244+78U/L, P=0.000; 16.7+4.6mg/L vs. 9.3+3.1mg/L, P=0.000).(2)Analyses between clinical characteristics and ORR revealed that early stages(I-II) patients had a higher ORR than that of advanced stages(72.6% vs. 50%,P=0.047). Patients with low IPI had a more favourable ORR(86.2%) than high(44.4%)and moderate(61.4%) group(P=0.018, 0.010). There was no statistical difference between latter two groups(P=0.336). Other clinical features were irrelevant to ORR.(3)Univariate analysis showed patients with early stages or relapsed disease had a significantly longer PFS compared to advanced or refractory disease(13.1 vs.7.5months, 10.1 vs.7.3 months). The stage and status of disease were two independent predictors on PFS by multivariate analysis(HR 4.004, P=0.000; HR 3.831, P=0.000).Conclusion:1. Compared with GEMOX and ICE therapy, bendamustine has better short term effects, meanwhile can prolong PFS. The adverse reactions of bendamustine are lighter than the conventional GEMOX and ICE regimens.2. Early stage and lower IPI are associated with better ORR. PFS is longer in early or relapsed patients. The stage and status of disease are two independent predictors on PFS of i NHL patients. |
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