Survival analysis of patients with diffuse large B-cell lymphoma after chemotherapy using <italic style="font-style: italic">Fuzheng Jiedu</italic> Formula and its mechanism of action on lymphocyte subsets

LI Xi; ZHOU Wenyi; ZHUANSUN Shiya; YUAN Xinbei; YANG Yijie; FU Hua; SHEN Wei; XU Min; GAN Xinjin; LU Jiahui

doi:10.3969/j.issn.1006-2157.2024.11.016

您当前的位置：

首页 >

文章列表页 >

Survival analysis of patients with diffuse large B-cell lymphoma after chemotherapy using Fuzheng Jiedu Formula and its mechanism of action on lymphocyte subsets

Hematology and Oncology | 更新时间：2024-12-02

- Survival analysis of patients with diffuse large B-cell lymphoma after chemotherapy using Fuzheng Jiedu Formula and its mechanism of action on lymphocyte subsets
- Journal of Beijing University of Traditional Chinese Medicine Vol. 47, Issue 11, Pages: 1603-1611(2024)
- 作者机构：
  
  1.上海中医药大学附属龙华医院　上海　200032
  2.上海中医药大学附属市中医医院
- 作者简介：
  
  LU Jiahui, Ph.D., Chief Physician, Doctoral Supervisor. Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, No.274, Middle Zhijiang Road, Jing′an District, Shanghai 200071. E-mail: lujiahui73@163.com
- 基金信息：
  
  Special Major Project of Medical Innovation Research of Shanghai Science and Technology Commission(21Y31920400)
- DOI：10.3969/j.issn.1006-2157.2024.11.016
  CLC： R273
- Received：20 June 2024，
  
  Published Online：04 November 2024，
  
  Published：30 November 2024
- 稿件说明：
移动端阅览
LI Xi, ZHOU Wenyi, ZHUANSUN Shiya, et al. Survival analysis of patients with diffuse large B-cell lymphoma after chemotherapy using Fuzheng Jiedu Formula and its mechanism of action on lymphocyte subsets[J]. Journal of beijing university of traditional chinese medicine, 2024, 47(11): 1603-1611.
DOI：

LI Xi, ZHOU Wenyi, ZHUANSUN Shiya, et al. Survival analysis of patients with diffuse large B-cell lymphoma after chemotherapy using Fuzheng Jiedu Formula and its mechanism of action on lymphocyte subsets[J]. Journal of beijing university of traditional chinese medicine, 2024, 47(11): 1603-1611. DOI： 10.3969/j.issn.1006-2157.2024.11.016.

摘要

目的

评价扶正解毒方辨治化学治疗(简称“化疗”)后弥漫性大B细胞淋巴瘤(DLBCL)患者的生存情况，并探究淋巴细胞亚群水平与化疗后DLBCL患者生存的关联。

方法

收集2013年1月1日—2023年12月31日就诊于上海中医药大学附属龙华医院、上海同济大学附属东方医院血液科门诊及病房所有确诊DLBCL并已完成化疗，且疗效达到完全缓解(CR)或部分缓解(PR)的患者，共234例。采用队列研究设计，将“化疗后是否连续接受≥6个月扶正解毒方治疗”作为暴露因素，将符合此暴露因素的患者分入中医队列，不符合此暴露因素的患者分入观察队列。比较2个队列患者1、2年无进展生存率、总生存率及持续缓解时间(DOR)，绘制2个队列无进展生存时间、总生存时间的生存曲线，并进行亚组生存分析，进一步筛选影响疾病进展的因素，并观察扶正解毒方对患者淋巴细胞亚群计数水平的影响。

结果

本研究共纳入234例化疗后DLBCL患者，其中，中医队列126例，观察队列108例。与观察队列比较，中医队列2年无进展生存率、2年总生存率、DOR升高(均

0.05)。中医队列的PFS高于观察队列[

＝0.542，95%

(0.345～0.853)，

0.01

]

。亚组分析结果显示，年龄≥60岁、安娜堡(AA)分期Ⅲ～Ⅳ期、CD4

＋

正常范围下限(LLN)亚组中，中医队列的无进展生存时间高于观察队列(均

0.05)。COX回归结果显示，AA分期Ⅲ～Ⅳ期[

＝2.180，95%

(1.064～4.466)，

0.05

]

、CD4

＋

LLN [

＝2.840，95%

(1.253～6.434)，

0.05

]

是化疗后DLBCL疾病进展的独立危险因素；中医队列为保护性因素[

＝0.538，95%

(0.297～0.974)，

0.05

]

，可将疾病进展风险降低46.2%。淋巴细胞亚群绝对计数分析结果显示，中医队列治疗前后比较，诱导化疗结束后2年较诱导化疗结束时CD3

＋

、CD4

＋

、CD19

＋

升高(均

0.05)；2个队列比较，中医队列CD3

＋

、CD4

＋

差值扩大，观察队列CD3

＋

、CD4

＋

差值缩小，2个队列的变化差异有统计学意义(均

0.05)。

结论

扶正解毒方维持治疗可以提高化疗后DLBCL患者的生存率，延长生存时间，在年龄≥60岁、AA分期Ⅲ～Ⅳ期、CD4

＋

LLN的人群中获益更加明显。扶正解毒方可明显降低化疗后DLBCL患者的疾病进展风险，并改善患者的免疫细胞水平。在西医化疗结束后，序贯维持扶正解毒方治疗可以为DLBCL患者带来更好的疗效。

Abstract

Objective

To evaluate the survival of patients with diffuse large B-cell lymphoma (DLBCL) after chemotherapy using

Fuzheng Jiedu

Formula and to explore the intrinsic correlation between the lymphocyte subset level and the survival of patients with DLBCL.

Methods

A total of 234 patients with DLBCL who had completed chemotherapy and achieved complete or partial response in the Department of Hematology

Longhua Hospital Shanghai University of Traditional Chinese Medicine and Shanghai East Hospital

Tongji University from January 1

2013

to December 31

2023

were recruited. A cohort study design was adopted

with " whether to receive continuous

Fuzheng Jiedu

Formula treatment for ≥ 6 months after chemotherapy" as the exposed factor. Patients meeting this exposed factor were divided into the traditional Chinese medicine (TCM) cohort

whereas those who did not meet this exposed factor were divided into the observation cohort. The 1- and 2-year progression-free survival (PFS) rate

overall survival (OS) rate

and duration of response (DOR) of the two cohorts were compared. The survival curves of PFS and OS of the two cohorts were drawn

and subgroup survival ana

lysis was performed to determine factors affecting disease progression. The effect of

Fuzheng Jiedu

Formula on lymphocyte subset count level was observed.

Results

The study included 126 and 108 patients in the TCM and observation cohorts

respectively. Compared with the observation cohort

the 2-year PFS rate

2-year OS rate

and DOR were increased in the TCM cohort (

0.05). The PFS in the TCM cohort was higher than that in the observation cohort [

=0.542

95%

(0.345-0.853)

0.01

]

. The result of subgroup analysis showed that PFS in the TCM cohort was higher than that in the observation cohort in the age ≥60 years

AA stage Ⅲ-Ⅳ

CD4

lower limits of normal(LLN) subgroup(

0.05). COX regression result showed that AA stage Ⅲ-Ⅳ[

=2.180

95%

(1.064-4.466)

0.05

]

and CD4

LLN [

=2.840

95%

(1.253-6.434)

0.05

]

were independent risk factors for DLBCL progression after chemotherapy. The TCM cohort had a protective factor [

=0.538

95%

(0.297-0.974)

0.05

]

that could reduce the risk of disease progression by 46.2%. The result of absolute lymphocyte subset count analysis showed that in the TCM cohort

CD3

CD4

and CD19

levels were significantly higher 2 years after end of induction therapy(EOI) compared to at EOI (

0.05). When comparing the two cohorts

the differences in CD3

and CD4

levels widened in the TCM cohort while narrowing in the observation cohort

and these changes between the two cohorts were statistically significant (

0.05).

Conclusion

Maintenance treatment with

Fuzheng Jiedu

Formula can improve the survival rate of p

atients with DLBCL after chemotherapy and prolong their survival time. The benefits of this treatment are apparent in the age ≥ 60 years

AA stage Ⅲ-Ⅳ

and CD4

LLN cohort.

Fuzheng Jiedu

Formula can significantly reduce the risk of disease progression in patients with DLBCL after chemotherapy and increase the immune cell level. After completing chemotherapy

the sequential maintenance treatment with

Fuzheng Jiedu

Formula can offer significant survival benefits for patients with DLBCL.

关键词

Keywords

references

XU PP , HUO YJ , ZHAO WL . All roads lead to targeted diffuse large B-cell lymphoma approaches [J ] . Cancer Cell ， 2022 ， 40 ( 2 ): 131 － 133 .

李小秋，李甘地，高子芬，等 . 中国淋巴瘤亚型分布：国内多中心性病例10002例分析 [J ] . 诊断学理论与实践， 2012 ， 11 ( 2 )： 111 － 115 .

朱逸东，甘欣锦．扶正解毒方辨治弥漫大B细胞淋巴瘤免疫逃逸的临床研究 [J ] . 中医学报， 2022 ， 37 ( 2 )： 408 － 412 .

沈悌，赵永强 . 血液病诊断及疗效标准 [M ] . 4版 . 北京：科学出版社， 2018 : 220 － 227 .

中国抗癌协会淋巴瘤专业委员会，中国医师协会肿瘤医师分会，中国医疗保健国际交流促进会肿瘤内科分会 . 中国淋巴瘤治疗指南(2021年版) [J ] . 中华肿瘤杂志， 2021 , 43 ( 7 ): 707 － 735 .

陈信义，杨文华 . 中医血液病学 [M ] . 北京：中国中医药出版社， 2019 ： 196 － 206 .

陈信义，陈志雄，邱仲川 . 常见血液病中医诊疗范例 [M ] . 北京：科学技术文献出版社， 2005 ： 220 － 228 .

陶丽新，刘一松，胡良平 . 基于SAS软件实现样本含量估计及应用 [J ] . 四川精神卫生， 2016 , 29 ( 5 )： 401 － 405 .

WANG SS . Epidemiology and etiology of diffuse large B-cell lymphoma [J ] . Semin Hematol , 2023 , 60 ( 5 ): 255 － 266 .

孙璐．中国人弥漫性大B细胞淋巴瘤免疫亚型、遗传学异常及其与临床预后相关性的研究 [D ] . 北京：中国人民解放军医学院， 2014 .

DABROWSKA-IWANICKA AP , NOWAKOWSKI GS . DLBCL: Who is high risk and how should treatment be optimized？ [J ] . Blood , 2023 ， 11 : 2023020779 .

王硕，王黎，胡建达，等．难治性弥漫性大B细胞淋巴瘤临床结局：一项来自中国的多中心真实世界研究 [J ] . 癌症， 2021 ， 40 ( 12 )： 523 － 533 .

AL-SARAYFI D , BRINK M , CHAMULEAU ME D , et al . R-miniCHOP versus R-CHOP in elderly patients with diffuse large B-cell lymphoma: a propensity matched population-based study [J ] . Am J Hematol , 2024 , 99 ( 2 ): 216 － 222 .

ZHANG J , CHEN BA . Analysis of risk factors related to relapse and refractory DLBCL and study of DLBCL maintenance therapy [J ] . Blood , 2020 , 136 ( Supplement 1 ): 32 － 33 .

肖汇颖，胡冬菊，王永敏，等 . 石龙解毒方辅助化疗对弥漫大B细胞淋巴瘤预后和生活质量的影响 [J ] . 中药新药与临床药理， 2022 , 33 ( 1 ): 126 － 131 .

LIANG H , GUO J , LI CG . Long-term complete remission of a patient with double-hit diffuse large B-cell lymphoma treated by chemoimmunotherapy and Chinese herbal medicine [J ] . Integr Cancer Ther , 2023 , 22 : 15347354221147515 .

朱伟嵘，赵夏，阮铭，等 . 芩黄合剂对弥漫大B细胞淋巴瘤患者免疫功能的影响 [J ] . 中成药， 2018 , 40 ( 9 ): 1930 － 1934 .

胡明，狄前程，胡琦，等．解毒消瘤方提高B细胞非霍奇金淋巴瘤患者无进展生存期的回顾性队列研究 [J ] . 现代中医临床， 2023 ， 30 ( 1 )： 31 － 37 .

武昊明，李希，甘欣锦，等．扶正化痰解毒方延缓惰性B细胞淋巴瘤进入西医干预阶段临床观察 [J ] . 山西中医， 2022 ， 38 ( 10 )： 19 － 21 .

李捷凯，朱文伟，张福鹏，等．消瘤方对弥漫大B细胞淋巴瘤正虚痰凝型患者M2型巨噬细胞极化与其趋化因子的影响 [J ] . 时珍国医国药， 2023 ， 34 ( 2 )： 285 － 288 .

王秀梅，王淋，廖永梅．不同类型恶性淋巴瘤患者体内免疫指标水平分析 [J ] . 海南医学院学报， 2017 ， 23 ( 12 )： 1690 － 1692 .

TAKAHARA T , NAKAMURA S , TSUZUKI T , et al . The immunology of DLBCL [J ] . Cancers , 2023 , 15 ( 3 ): 835 .

AUTIO M , LEIVONEN SK , BRÜCK O , et al . Immune cell constitution in the tumor microenvironment predicts the outcome in diffuse large B-cell lymphoma [J ] . Haematologica , 2021 , 106 ( 3 ): 718 － 729 .

江志红，江雅婷，王晓娜，等 . 初治弥漫大B细胞淋巴瘤患者化疗后T淋巴细胞亚群变化 [J ] . 中国临床医学， 2023 , 30 ( 3 ): 480 － 485 .

YANG Z , YU W . Clinical significance of circulating neutrophils and lymphocyte subsets in newly diagnosed patients with diffuse large B-cell lymphoma [J ] . Clin Exp Med , 2023 , 23 ( 3 ): 815 － 822 .

谢宇，包红雨，施小凤，等 . 细胞因子及淋巴细胞亚群在弥漫大B细胞淋巴瘤患者中的表达及临床意义 [J ] . 中国实验血液学杂志， 2023 , 31 ( 4 ): 1061 － 1068 .

王娅．外周血淋巴细胞亚群对弥漫大B细胞淋巴瘤疗效的预测价值及模型构建 [D ] . 南昌：南昌大学， 2024 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Immunological characteristics of different TCM patterns in primary immune thrombocytopenia patients with failed first-line treatment and response to eltrombopag

Therapeutic effect and mechanism of Yiqi Tongyang Granule in treating immune thrombocytopenia model mice

Efficacy of Fuzheng Jiedu Formula in children with continuous or chronic immune thrombocytopenia and pattern of qi failing to control blood

Related Author

WU Dijiong

ZHOU Yuhong

YE Baodong

SHEN Yiping

GAO Yanting

WANG Jun

LI Yuzhu

SHEN Yingying

Related Institution

Department of Hematology, First Affiliated Hospital of Zhejiang Chinese Medical University(Zhejiang Provincial Hospital of Chinese Medicine)

The First School of Clinical Medicine, Zhejiang Chinese Medical University

Xiyuan Hospital, China Academy of Chinese Medical Sciences

Dongzhimen Hospital of Beijing University of Chinese Medicine

AI问答

Postal code：100029
Tel：(010)53911857 Email：jbutcm@bucm.edu.cn
Technical support is provided by Beijing Founder electronics co., LTD 京ICP备09064830号-19 京公网安备11010802024621
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰

Survival analysis of patients with diffuse large B-cell lymphoma after chemotherapy using Fuzheng Jiedu Formula and its mechanism of action on lymphocyte subsets

DOI：10.3969/j.issn.1006-2157.2024.11.016

摘要

Abstract

关键词

Keywords

references