| Background and PurposeDiffuse large B-cell lymphoma(DLBCL)is the most common non-Hodgkin's lymphoma(NHL),accounting for approximately 30?40%of NHL.DLBCL can occur at all ages and has a high incidence in adults,and it is a group of B-cell lymphoma with strong heterogeneity.Pathologically it is characterized by diffusely distributed malignant large B lymphocytes,clinically presenting an invasive course,which is typically a rapidly increasing painless mass.With the advent of the CD20-targeting monoclonal antibody rituximab,R-CHOP(rituximab combined with vincristine,cyclophosphamide,doxorubicin and prednisone),as the the first-line standard chemotherapy regimen has greatly improved the response and survival rate of DLBCL patients,but 30%?40%of patients still do not response to the first-line chemotherapy,or relapse.Currently,there is no optimal recommendation in the National Comprehensive Cancer Network(NCCN)guidelines for the standard second-line chemotherapy for relapsed or refractory DLBCL(R/R DLBCL),and despite with the salvage treatment,most patients have a poor prognosis and extremely high mortality.Our study compared and analyzed the efficacy,side effects and prognostic factors of the commonly used second-line chemotherapy regimen DA-EPOCH±R and modified ESHAP±R for R/R DLBCL,improving the reference value for clinical treatment.Materials and Methods1.A total of 579 patients with R/R DLBCL patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2018 were selected,excluding patients did not meet the inclusion criteria.161 patients who received the treatment regimen of DA-EPOCH±R or modified ESHAP±R were enrolled.Data of 161 R/R DLBCL patients were collected and follow-up data were established.2.Clinical characteristics and survival data of 161 patients with R/R DLBCL were retrospectively studied.The short-term and long-term effects of the treatment between DA-EPOCH±R regimen and modified ESHAP±R regimen were compared,and the side effects of the two regimens were compared.3.Gender,age,Ann-arbor stage,IPI score,serum LDH level,?2 microglobulin,cell of origin and other characteristics of patients with R/R DLBCL treated with DA-EPOCH±R regimen or modified ESHAP±R regimen were analyzed to search for independent prognostic factors affecting the survival of patients.Statistical methodStatistical software SPSS24.0 was used to analyze the data.The chi-square test and Mann Whitney test were used to compare categorical variables of the groups(DA-EPOCH±R group and modified ESHAP±R group).The survival rate of the whole group and each subgroup were analyzed by Kaplan-Meier method.and the survival difference between two groups was analyzed by Log-rank method.COX proportional hazards regression model was used to analyze the prognostic factors affecting the survival of patients.If the bilateral P value was<0.05,the difference was considered to be statistically significant.Results1.Clinical features:The median age of 161 patients with R/R DLBCL was 50 years(range:12-77 years),of which 125 cases(77.6%)were refractory and 36 cases(22.4%)were relapsed.121 Cases(75.2%)had a grade ?/? Ann Arbor stage,and 98 cases(60.9%)had an IPI score of 3-5.Among the 83 patients(51.6%)in the DA-EPOCH±R group and 78(48.4%)in the modified ESHAP±R group,there was no statistical difference in the clinical characteristics between the two groups(P>0.05).2.Short-term efficacy:The ORR of DA-EPOCH±R group was significantly prior than that of the modified ESHAP±R group(67.5%vs.51.3%,P=0.036).3.Long-term efficacy:The median follow-up time of 161 R/R DLBCL patients was 20 months(range:1-76 months),71 patients(44.1%)could be followed up,70 patients(43.5%)died,and the remaining 20 patients(12.4%)had been lost to follow-up.The 2-year PFS rate of 161 cases was 41.1%,the 2-year OS rate was 45.3%,the median PFS was 6 months,and the median OS was 29 months.The PFS and OS of the DA-EPOCH±R group were significantly prior than that of the modified ESHAP±R group(2-year PFS:46.7%vs.25.8%,P=0.039;2-years OS:54.7%vs.33.3%,P=0.046).4.Side effects:The side effects of the DA-EPOCH±R group and the modified ESHAP±R group were divided into hematological toxicity and non-hematological toxicity,mainly including myelosuppression,gastrointestinal reactions,baldness,mucositis,etc.There were no significant differences in the incidence of side effects between the two groups(P>0.05).5.Univariate and multivariate analysis:Among the univariate analysis results,IPI score(?2=15.300,P<0.001),cell of origin(?2=6.608,P=0.010),serum LDH(?2=5.683,P=0.017),and second-line chemotherapy efficacy(?2=16.512,P<0.001)were the prognostic factors affecting patients in the DA-EPOCH±R group.IPI score(?2=43.973,P<0.001),number of extranodal lesions involved(?2=7.086,P=0.008),serum LDH(?2=7.412,P=0.006),and efficacy of second-line chemotherapy(?2=22.848,P<0.001)were related to the prognosis of patients in the modified ESHAP±R group.The COX multivariate analysis results of DA-EPOCH±R group and modified ESHAP±R group both showed that IPI score and efficacy of second-line chemotherapy were independent prognostic factors affecting the survival of patients(P<0.05).Conclusion1.The clinical efficacy of R/R DLBCL with DA-EPOCH±R regimen was better than that with modified ESHAP±R regimen.2.The incidence of side effects of DA-EPOCH±R regimen was similar to that of modified ESHAP±R regimen.3.IPI score is a prognostic factor for R/R DLBCL,and remission after second-line chemotherapy can prolong the survival of patients. |
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