RCHOP和RCDOP方案治疗弥漫大B细胞淋巴瘤后间质性肺炎发生率的研究

OBJECTIVE: To identify the risk factors and clinical features associated with the interstitial pneumonia in diffuse large B-cell lymphoma（DLBCL）patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone（RCHOP）or rituximab, cyclophosphamide, liposomal doxorubicin, vincristine and prednisone（RCDOP）regimens. METHODS: A retrospective study was conducted in 836 patients with DLBCL admitted to the Department of Hematology at Ruijin Hospital from 2013 to 2018. Among them, 114 patients were treated with RCDOP regimen. Using the method of propensity score matching according to age, gender, IPI score of patients, 114 patients treated with RCHOP regimen were selected as controls. Clinical data, including comorbidities, gender, age, B symptoms, international prognostic index（IPI）score, disease stage, serum lactic dehydrogenase（LDH）and β 2 microglobulin（β 2-MG）level were collected and the risk factors of interstitial pneumonia were further analyzed. RESULTS: The interstitial pneumonia developed more frequently in RCDOP group than RCHOP group（28.95％ vs 2.60％, P<0.01）. As the dose of liposomal doxorubicin elevated from 25-30 mg/m(2) to 35-40 mg/m(2) , the incidence of interstitial pneumonia accordingly increased from 17.30％ to 38.71％（P<0.05）. By multivariate analysis, disease stage was an independent factor of interstitial pneumonitis. CONCLUSION: Front line regimens containing liposomal doxorubicin in DLBCL patients link to a higher incidence of dose-dependent interstitial pneumonia. Prevention and surveillance should be emphasized in future studies.