Efficacy analysis of rituximab combined with CHOP or EPOCH regimen in treatment of diffuse large B-cell lymphoma with newly diagnosed myc/bcl-2 double-expression / 白血病·淋巴瘤

ABSTRACT

Objective To evaluate the efficacy, safety and the prognosis of rituximab combined with CHOP (R-CHOP) or combined with EPOCH (R-EPOCH) regimen in treatment of newly diagnosed myc/bcl-2 double-expression diffuse large B-cell lymphoma (DLBCL). Methods The clinical efficacy, adverse reactions and survival of 16 DLBCL patients who received R-CHOP regimen with double-expression and 15 DLBCL patients who received R-EPOCH regimen with double-expression between August 2014 and December 2017 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed, and all patients with double or triple-hit lymphoma were excluded. Results The ratio of the International Prognostic Index (IPI) score ≥3 in R-EPOCH group was higher than that in R-CHOP group [10 cases vs. 5 cases, χ2＝ 3.888, P＝0.049]. There were no statistical differences in other clinical data of both groups. Complete remission (CR) was achieved in 75% (12/16) of R-CHOP group and 67% (10/15) of R-EPOCH group, and there was no statistical difference between the two groups (χ2＝ 0.013, P＝ 0.908). The incidence of grade 3-4 leukopenia and grade 3-4 thrombocytopenia in R-EPOCH group was higher than that in R-CHOP group, and the difference was statistically significant [93% (14/15) vs. 38% (6/16), χ 2＝ 10.542, P＝ 0.01; 73% (11/15) vs. 6% (1/16), χ 2＝ 14.685, P< 0.01]. The 1-year overall survival (OS) rate and progression-free survival (PFS) rate was 86.5% and 81.3% in R-CHOP group, 76.0% and 51.4% in R-EPOCH group. There was no statistical difference in the 1-year OS rate between the two groups (P＞0.05), and the 1-year PFS rate in R-CHOP group was higher than that in R-EPOCH group (P<0.01). The 1-year OS rate and PFS rate was 100.0% and 93.8% in IPI<3 group, 65.5% and 45.0% in IPI≥3 group. The 1-year OS rate and PFS rate in IPI<3 group were superior to those in IPI≥3 group (all P ＞0.01). The 1-year OS rate and PFS rate of the female group were lower than those of the male group (59.6% vs. 100.0%, 44.2% vs. 86.3%), and there were statistical differences (all P<0.01). Cox regression analysis showed that high IPI score was an independent prognostic factor for all patients ( HR＝6.335, 95% CI 0.740-54.261, P＝0.092). Conclusions R-EPOCH and R-CHOP are the ideal treatment methods for the double-expression lymphoma. Both regimens have similarities in the treatment outcome of myc/bcl-2 double-expression DLBCL. The adverse reactions in R-EPOCH group are severer than those in R-CHOP group.