利妥昔单抗联合CHOP化疗方案治疗B细胞非霍奇金淋巴瘤感染病例观察.doc

利妥昔单抗联合CHOP化疗方案治疗B细胞非霍奇金淋巴瘤感染病例观察 中国临床医学2010年I2月第17卷第6期ChineseJournalofClinicalMedicine,2010.Vo1.17,No.6889 利妥昔单抗联合CHOP化疗方案治疗 非霍奇金淋巴瘤感染病例观察 冯艺周宇红 (复旦大学附属中山医院分部肿瘤内科,上海200052) 论着 B细胞 摘要目的:观察利妥昔单抗联合环磷酰胺+多柔比星+长春新碱+强的松(R—CHOP)化疗方案治疗B细胞非霍奇金淋巴瘤 (NHL)期间发生感染的病例,探究其发生的原因并了解间质性肺炎发生的比例.方法:收集我科2005年6月一2【)(】9年9月 病理确诊CD20阳性的24例B细胞NHI患者的临床资料,初治接受RCHOP方案治疗,5(2～6)疗程.结果:24例患者中完 全缓解(CR)13例(54.2);部分缓解(PR)6例(25);总反应率(OR)为79.2.24例患者治疗过程中伴发感染12例,其中 细菌性肺炎6例,间质性肺炎4例;皮肤带状疱疹2例.12例感染病例中,感染时与R—CHOP方案治疗前相比,血乳酸脱氢酶 (LDH)升高5例(41.6),82微球蛋白升高7例(58.3);感染与未感染病例相比,发生低免疫球蛋白血症的分别有6例 (60)和4例(33.3);CD4计数下降分别是4例(33.3)和1例(8.3);CD19计数下降比例与CD4/CD8下降比例相似. 结论:R—cHOP方案治疗B细胞NHL具有良好的临床疗效,但在治疗过程中需警惕间质性肺炎的发生,密切监测血清乳酸脱 氢酶(LDH),t72微球蛋白,免疫球蛋白及T淋巴细胞亚群可以对感染的发生有所预测. 关键词利妥昔单抗;间质性肺炎;低免疫球蛋白血症 中图分类号R733.1文献标识码A TheObservationStudyofInfectionCasesOccurredduringRituximabinCombinationWithCHOPChemother- apyforBCellNon—Hodgkin’sLymphomaFENGZH0UYuhongDepartmentofOncology,Zhongs— hanHospital,FudanUniversitY,Shanghai200052,China AbstractObjective:T.observetheinfectioncasesoccurredduringthecombinationofrituximabwithcyclophosphamide+ doxorubicin+vincristine+prednisone(R—CHOP)regimeninthetreatmentofpatientswithBcellnon—Hodgkin’slymphoma (NHL),trytofindthereasonwhytheinfectionoccurredandfindouttheproportionofinterstitialpneumonia.Methods: TwentyfourpatientswithCD20positiveB-cellNHLreceivedR—CHOPregimefromJune2005toSeptember2009byamedian of5cycles(rangedfrom2to6cycles).Results:Ofthe24patients,thecompleteresponse(CR)ratewas54.2,thepartialre— sponse(PR)ratewas25andtheoverallresponse(OR)ratewas79.2.12patientsoccurredinfectionduringthetreatment,4 caseswithinterstitialpneumonia,6caseswithbacterialpneumoniaand2caseswithHerpesZoster.Ofthe12patientswhooc— curredinfection,5patientswiththeelevationoftheserumlactatedehydrogenace(LDH)and7patientswiththeelevationofthe serumBeta2一MGcomparedwiththedatabeforethetreatment.Comparedtheinfectionpatientswithnon—infectionpatients,the occurrenceofhypogammaglobulinemiawere6casesand4casesrespectively,thedeclineofCD4