Preliminary clinical observation of combinational chemo-immunotherapy of R-CHOP and interleukin-2 in patients with diffuse large B-cell lymphoma

目的 探讨白细胞介素2(IL-2)联合R-CHOP方案扩增NK细胞数及增强利妥昔单抗临床疗效的可性.建立IL-2与R-CHOP联合治疗弥漫大B细胞淋巴瘤(DLBCL)的临床用药方法.方法 选取2008年8月至2009年3月住院治疗的初治DLBCL患者24例,进行前瞻性非随机同期对照研究,治疗组12例采用IL-2联合R-CHOP方案治疗;对照组12例仅采用R-CHOP治疗.通过流式细胞术(FCM)检测治疗组与对照组NK细胞数的变化,并观察临床疗效及不良反应.结果 治疗组完全缓解(CR)率为60%(6/10),总有效(OR)率为80%(8/10);对照组CR率50%(5/10),OR率70%(7/10).治疗组NK细胞绝对值较对照组显著升高(P=0.015).治疗组化疗前后NK细胞百分率降低的幅度低于对照组,差异具有统计学意义(P=0.005).化疗后使用IL-2后NK细胞百分率较使用IL-2前明显升高(P=0.03).治疗组10例患者中出现腹泻3例、发热3例.结论 IL-2联合R-CHOP可以提高DLBCL患者体内NK细胞数量,可能减弱化疗对NK细胞的杀伤作用,且不良反应可以耐受,值得进一步研究.Objective To explore the feasibility of expansion for NK cells and the therapeutic efficacy improvement of rituximab by combinational Chemo-immunotherapy of rituximab and inter]eukin-2. To establish a clinical chemo-immunotherapy therapy regime of rituximab and interleukin-2(IL-2) for patients with diffuse large B-cell lymphoma (DLBCL). Methods The clinical data of 24 initially treated inpatients with DLBCL from Aug 2008 to Mar 2009 were analyzed by prospective non-randomized study. Patients in the treatment group (12 cases) were treated by IL-2 plus R-CHOP regime and those in the control group (12 cases)only by R-CHOP. The absolute quantity of NK cells before and after IL-2 and/or R-CHOP treatment in both groups were detected with FCM and compared, and the therapy efficacy and adverse reactions were evaluated.Results The complete remission (CR) rate was 60%(6/10) and the overall response (OR)rate was 80%(8/10)in the treatment group. The CR rate was 50%(5/10) and the OR rate was 70 %(7/10) in the control group.The proliferation of the NK cells in the treatment group was significantly effective compared with that in the control group (P=0.015). The descending range of NK cells between pre-and post-treatment in the treatment group was significantly lower than that in the control group(P =0.005). The quantity of NK cells after treatment by IL-2 was significantly increased than that before treatment by IL-2 in the treatment group (P=0.03). Among 10 patients in the treatment group, 3 cases have got diarrhea and 3 fever. Conclusion Treatment by IL-2 plus R-CHOP can increase the NK cell quantity in patients with DLBCL and may reduce lethal effect for NK cells by chemotherapy. The patients can tolerant the adverse reactions of IL-2 combined with R-CHOP therapy.08471-4741