Efficacy Analysis On Rituximab Combined With Chemotherapy In The Treatment Of Diffuse Large B-cell Lymphoma And Bcl-2 Protein Overexpression

Objective To retrospectively analyze the effect of CHOP chemotherapy plus rituximab(R-CHOP) and CHOP chemotherapy alone on the previously untreated diffuse large B-cell lymphoma(Diffuse large B-cell lymphoma, DLBCL) patients, thus to explore the correlate prognostic factors affecting the outcome and the possibility of whether the rituximab can improve DLBCL patients with Bcl-2 overexpression.Methods In total 108 patients of DLBCL clinically diagnosed in our hospital from Jan. 2009 to Jun. 2013 were enrolled, based on its staging(Ann Arbor), IPI score, ECOG score and chemotherapy before the examination, including: physical examination, routine laboratory tests, chest, abdomen,pelvis, and other related parts of the CT and bone marrow examination. According to the results of assessment and relative conditions of patients, patients were treated with either CHOP or R-CHOP chemotherapy. Patients with one more extranodal sites or special parts( eyes, sinuses, breast, testes, bone and bone marrow) involved, were treated with Intrathecal injection to prevent the Central nervous system leukemia. After 6/8 cycle of CHOP or R-CHOP therapy, the effacy of DLBCL patients were assessed every three months in the first year, every 6 months in the second year, and once three years later. The therapy efficacy was assessed according to the International Work Organization lymphoma efficacy evaluation criteria(IWC), and PET-CT was based on the revised standard criteria. SPSS20.0statistical software was used for analysis, the Fisher’s exact test / ANOVA was used to compare clinical characteristics, Kaplan-Meier survival curves for survival analysis, and the Log-rank method was for univariate analysis while COX regression for multivariate analysis,,P <0.05 was considered statistically analyzed.Results The CR + CRu rate in R-CHOP group was significantly higher than CHOP alone group(70% vs 44%, P = 0.010.); The OS in R-CHOP group was significantly longer than CHOP group in two years(Log Rank(Mantel-Cox): Х2 = 5.066 P = 0.024). Univariate analysis showed that : the choice of treatment(P = 0.024), age> 60 years(P = 0.008), IPI> 2(P = 0.001), the number of extranodal involvement > 1(P = 0.003), LDH> normal value(P = 0.000), whether there is the CR(P = 0.000) or bcl-2 overexpression(P = 0.032) is a poor prognostic factor in DLBCL. Multivariate regression analysis on the above factors showed: patients older than 60 years(HR(95 % CI): 3.724(1.519,9.131), P = 0.004), LDH increased(HR(95% CI): 5.915(2.338,14.969), P = 0.000) and the treatment of less than complete remission(HR(95% CI) :3.545(1.367,9.197), P = 0.009), and treatment whether includes rituximab(HR(95% CI):0.408(0.166,1.003), P = 0.050) were independent prognostic factors in patients with DLBCL.55.5%(60/108) DLBCL patients with overexpression of bcl-2: the rate of bcl-2 + CR+ CRu was significantly lower than the bcl-2- in the CHOP(26.9% vs. 63.2%, P = 0.016),while no statistical difference was found between groups between bcl-2 + and bcl-2- ’s CR +CRu in the R-CHOP(70.6% vs 69.0%, P = 1.000.); bcl-2- OS in CHOP group was significantly better than bcl-2 + group( P = 0.045), while no statistical difference was found between OS of bcl-2 + and bcl-2- comparison OS in R-CHOP(P = 0.568); the survival effect of R-CHOP in bcl-2 + group was significantly better than the CHOP group(P = 0.035), but the two therapy has no statistical impact on the bcl-2- group(P = 0.637).Conclusion Rituximab can significantly improve the complete remission and survival rate of DLBCL patients,But did not increase the incidence of drug side effects. Treatment programs are not related to rituximab, Patients older than 60 years, IPI> 2, extranodal involvement number> 1, LDH greater than normal, treatment less than CR and bcl-2 overexpression are poor prognostic factors in the therapy of DLBCL patients; ages, LDH, whether treatment achieved complete remission, and treatment options are independent prognostic factors; rituximab is able to overcome the failure of treatment in patients with bcl-2 overexpression.