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目的:探讨EPOCH±R序贯DICE±R方案治疗原发乳腺弥漫大B细胞淋巴瘤的疗效及安全性。方法:2000年1月至2016年4月我院收治原发乳腺弥漫大B细胞淋巴瘤43例,其中24例接受CHOP±R方案治疗,另19例接受EPOCH±R序贯DICE±R方案治疗,比较2组的临床疗效、预后及不良反应。结果:EPOCH±R序贯DICE±R序贯治疗组的缓解率高于CHOP±R方案组,分别为84.2%和70.8%,而且复发率低,两者分别为6.25%和35.3%,5年OS分别为73.3%和45.2%(P=0.043),PFS分别为75%和47.4%(P=0.035);EPOCH±R序贯DICE±R方案组血液学毒性高于CHOP±R方案组,其中白细胞Ⅳ度减少高达63.2%,而在CHOP±R为25%,但易于控制,无治疗相关死亡。多因素分析显示,年龄(P=0.008;95%CI 0.026-0.579)、乳酸脱氢酶(P=0.007;95%CI 0.017-0.531)和放疗(P=0.045;95%CI 1.028-14.719)是重要的预后因素。结论:EPOCH±R序贯DICE±R方案对乳腺弥漫大B细胞淋巴瘤是安全有效的,而年龄和乳酸脱氢酶水平为不良预后因素,局部放疗能改善患者的预后。
Objective: To investigate the efficacy and safety of EPOCH ± R sequential DICE ± R regimen in the treatment of primary breast diffuse large B cell lymphoma. Methods: From January 2000 to April 2016, 43 cases of primary breast diffuse large B cell lymphoma were treated in our hospital. Among them, 24 cases received CHOP ± R regimen and the other 19 cases received EPOCH ± R sequential DICE ± R regimen The clinical efficacy, prognosis and adverse reactions of two groups were compared. Results: The response rate of sequential EPOCH ± R sequential DICE ± R group was higher than that of CHOP ± R group (84.2% vs 70.8%, respectively), and the relapse rate was low (6.25% vs 35.3%, respectively) OS were 73.3% and 45.2% respectively (P = 0.043), PFS was 75% and 47.4% respectively (P = 0.035). The hematological toxicity of EPOCH ± R sequential DICE ± R regimen was higher than that of CHOP ± R regimen Grade IV leukopenia was as high as 63.2%, while CHOP ± R was 25% but was easily controlled with no treatment-related death. Multivariate analysis showed that age (P = 0.008; 95% CI 0.026-0.579), lactate dehydrogenase (P = 0.007; 95% CI 0.017-0.531) and radiation (P = 0.045; 95% CI 1.028-14.719) were Important prognostic factors. CONCLUSIONS: Sequential DICE ± R regimen of EPOCH ± R is safe and effective for diffuse large B-cell lymphoma in breast, while age and lactate dehydrogenase levels are poor prognostic factors. Radiotherapy may improve prognosis.