目的 评价CDOP方案（环磷酰胺+脂质体阿霉素+长春新碱+泼尼松）或R-CDOP方案（利妥昔单抗+环磷酰胺+脂质体阿霉素+长春新碱+泼尼松）一线治疗合并心血管疾病及相关危险因素的弥漫大B细胞淋巴瘤（DLBCL）患者的疗效和安全性。

方法  94例合并心血管疾病及相关危险因素（冠心病病史、高血压、年龄≥60岁、高血脂、糖尿病、肥胖、长期吸烟史）的DLBCL患者，16例采用CDOP方案化疗，78例采用R-CDOP方案化疗。回顾性分析其临床特征、治疗疗效与不良反应。

结果  94例患者中，伴有冠心病者10例，伴有高血压者33例，伴有高脂血症者44例，伴有糖尿病者23例，肥胖者15例，有长期吸烟史者25例，伴有甲亢或甲减者3例。74例患者伴有2项及以上心血管疾病或危险因素。病理分型为生发中心型（GCB）患者34例，非生发中心型（non-GCB）患者60例。94例患者接受中位4.5个周期化疗后，总有效率（ORR）和完全缓解率（CRR）率分别为92.6%（87/94）和70.2%（66/94）。接受R-CDOP方案化疗的78例患者，ORR与CRR分别为96.5%（75/78）和74.3%（58/78）。Ⅲ～Ⅳ度中性粒细胞减少、血小板减少发生率分别为53.2%（50/94）和3.2%（3/94）。19例患者出现Ⅰ～Ⅱ度心脏事件，未出现Ⅲ～Ⅳ度需要紧急治疗或中止化疗的心脏事件，未见化疗相关的远期心脏事件。总体5年无进展生存率为71.3%，5年总生存率为76.9%。GCB患者及non-GCB患者的5年无进展生存率分别为84.6%和63.9%（P＜0.05），5年总生存率分别为80.6%、74.6%%（P=0.407），无统计学差异。

结论 对于伴有心血管疾病或相关危险因素的DLBCL患者，应用含脂质体阿霉素的CDOP或R-CDOP方案进行一线治疗疗效确切，安全性良好。

ive  toevaluate the efficacy and safety profile of first-line cdop(cyclophosphamide, pegylated liposomal doxorubicin, vincristine, and prednisone) or r-cdop ( rituximab, cyclophosphamide, pegylated liposomal doxorubicin, vincristine, and prednisone) in diffuse large b-cell lymphoma (dlbcl) with cardiovascular diseases or risk factors.

 method  94 dlbcl patients who were diagnosed with at least one cardiovascular disease or risk factor and received first-line r-cdop/cdop chemotherapy in our institute were retrospectively reviewed. cardiovascular diseases or risk factors were referred as: coronary heart disease， hypertension，age ≥ 60, hyperlipidemia, diabetes mellitus, obesity, history of smoking, and hypothyroidism/hyperthyroidism.

result  all enrolled patients had history of a cardiovascular disease or presented a high-risk group of developing cardiovascular diseases: coronary heart disease 10cases, hypertension 33cases, hyperlipidemia 44cases, diabetes mellitus 23cases, obesity 15cases, history of smoking 25cases, hypothyroidism/hyperthyroidism 3cases.74 patients had more than one cardiovascular disease or risk factors. 34 patients were germinal center b -cell subtype (gcb) and 60 were non-germinal center b -cell subtype(non-gcb). first-line r-cdop/cdop chemotherapy was given at a median cycle of 4.5 (range, 2-8). overall response rate (orr) and complete response rate (crr) were 92.6%(87/94) and 70.2% (66/94) for the whole group, 96.5%(75/78) and 74.3%(58/78) for the r-cdop subgroup, respectively. grade ⅲ/ⅳ neutropenia and thrombocytopenia were documented in 53.2%(50/94) and 3.2% (3/94) of patients. 19 (20.2%) patients developed grade i/ii cardiotoxicity. there was no grade ⅲ/ⅳ cardiac event causing chemotherapy delay or break off. no further cardiotoxicity occurred neither during follow-up. 5-year progression-free survival (pfs) and overall survival（os）rates were 71.3% and 76.9% for overall. for gcb subtype and non-gcb subtype, 5-year pfs rates were 84.6% and 63.9% respectively（p＜0.05）, and 5-year os rates were 80.6% and 74.6% respectively（p=0.407）.

conclusion pld-containing first-line r-cdop/cdop regimen was demonstrated as an highly effective and much tolerable alternative for dlbcl patients with cardiovascular diseases/risk factors.