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目的 :探讨ICE方案(异环磷酰胺、依托泊苷、卡铂)方案挽救治疗复发难治性弥漫大B细胞淋巴瘤的疗效和安全性以及预后相关因素。方法 :52例复发难治性DLBCL患者接受ICE方案挽救治疗,评价近期疗效和不良反应,并进行生存分析和预后相关因素的单因素和多因素分析。结果 :52例患者的客观缓解率为61.5%(32/52)。不同性别、年龄、复发后结外病灶数(≤1个vs>1个)和肿瘤细胞来源[生发中心B细胞样(germinal-center B-cell-like,GCB)亚型vs非GCB亚型]的患者以及有无B症状患者的近期疗效差异均无统计学意义(P值>0.05);而Ki-67≥75%的患者,其近期疗效明显优于Ki-67<75%的患者(P=0.04)。52例患者的中位无进展生存时间为4.0个月(范围:0.5~60.0个月)。单因素分析结果显示,复发后结外病灶数和肿瘤细胞来源均与无进展生存显著相关(P值均<0.05),而年龄、性别、B症状和Ki-67均与无进展生存无显著相关性(P值均>0.05)。多因素分析结果显示,复发后结外病灶数和肿瘤细胞来源均是无进展生存的独立预后因素(P值均<0.05)。单因素分析结果显示,年龄、性别、B症状、复发后结外病灶数、Ki-67和肿瘤细胞来源均与总生存无显著相关性(P值均>0.05)。ICE方案的主要不良反应为骨髓抑制(80.8%),其中3/4级占55.8%。结论 :ICE方案可作为复发难治性DLBCL患者的挽救治疗方案,复发后结外病灶数和肿瘤细胞来源是ICE方案挽救治疗复发难治性DLBCL患者PFS的独立预后因素。
Objective: To investigate the efficacy and safety of ICE regimen (ifosfamide, etoposide, carboplatin) in the treatment of recurrent refractory diffuse large B cell lymphoma and related factors of prognosis. Methods: Fifty-two patients with relapsed and refractory DLBCL underwent ICE regimen to evaluate the short-term curative effect and side effects. The survival analysis and prognostic factors were analyzed by single factor and multivariate analysis. Results: The objective response rate of 52 patients was 61.5% (32/52). The number of extranodal lesions (≤ 1 vs> 1) and tumor cell origin [germinal-center B-cell-like (GCB) subtype versus non-GCB subtype] (P> 0.05). However, patients with Ki-67≥75% had significantly better immediate efficacy than patients with Ki-67 <75% (P <0.05), and there was no significant difference in the short- = 0.04). The median progression-free survival time for 52 patients was 4.0 months (range: 0.5-60.0 months). Univariate analysis showed that the number of extranodal lesions and the source of tumor cells were significantly associated with progression-free survival (P <0.05), while age, gender, B symptoms and Ki-67 were not significantly associated with progression-free survival (P> 0.05). Multivariate analysis showed that the number of extranodal lesions and the source of tumor cells were independent prognostic factors for progression-free survival (P <0.05). Univariate analysis showed that there was no significant correlation between age, gender, symptoms of B, number of extranodal lesions after recurrence, Ki-67 and the source of tumor cells (P> 0.05). The main adverse reaction of ICE regimen was myelosuppression (80.8%), of which 3/4 grade accounted for 55.8%. Conclusion: The ICE regimen can be used as a salvage treatment for patients with relapsed and refractory DLBCL. The number of extranodal lesions and the source of tumor cells after ICE are the independent prognostic factors of PFS in patients with refractory DLBCL.