NAPD方案治疗复发难治性非霍奇金淋巴瘤67例临床观察
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摘要
目的:观察NAPD方案(长春瑞滨、阿糖胞苷、顺铂、地塞米松)治疗复发难治性非霍奇金淋巴瘤的临床疗效和不良反应。方法:67例经一线方案化学药物治疗后的复发难治性非霍奇金淋巴瘤患者采用NAPD方案治疗,连续行2个周期后评价疗效,1个周期后评价不良反应。计算客观有效率(objective response rate,ORR)、临床获益率(clinical benefitrate,CBR)、总生存时间(overallsurvival,OS),无进展生存时间(progressfreesurvival,PFS)及1,2,4年OS及PFS。结果:2个周期化学药物治疗后,ORR为53.8%,其中5例(7.5%)获得完全缓解,31例(46.3%)获得部分缓解, CBR88.1%(59/67)。中位OS 22(1.5～140.0)个月,1,2,4年OS率分别为70.9%,49.0%,35.0%。中位PFS为14(1.5～140.0)个月;1,2,4年PFS率分别为57.5%,38.3%,29.8%。主要不良反应为骨髓抑制。III/IV度白细胞减少及血小板减少发生率分别为13.4%(9例)和3.0%(2例),消化道反应主要为I/II度,III/IV度消化道不良反应发生率为6.0%。无严重的心、肝、肾功能损害。结论:NAPD方案对复发难治性非霍奇金淋巴瘤疗效确切,不良反应较轻,值得进一步验证。
Objective: To explore the clinical efficacy and toxicity of the NAPD regimen(vinorelbine, cytarabine, cisplatin, and dexamethasone) in the treatment of recurrent refractory non-Hodgkin' s lymphoma.Methods: A total of 67 patients identified with recurrent refractory non-Hodgkin's lymphoma were enrolled for this retrospective study. The curative efficacy of NAPD regimen was evaluated aft er 2 consecutive cycles. The toxicities and side effects were evaluated aft er 1 cycle. The objective response rate(ORR), overall survival(OS), progress free survival(PFS), 1, 2 or 4 years of OS andPFS rates were analyzed. The prognosis was evaluated with univariate and multivariate analysis.Results: The ORR was 53.8% after two cycles, including 5(7.5%) complete responses and 31(46.3%) partial responses. The clinical benefit rate(CBR) was 88.7%(59/67). The median OS was 22(1.5–140.0) months. 1, 2 or 4 years of OS rates were 70.9%, 49.0%, and 35.0%, respectively. The median PFS was 14(1.5–140.0) months; and 1, 2 or 4 years of PFS rates were 57.5%, 38.3%, and 29.8%, respectively. The main side effect was myelosuppression. The rates of Grade III/IV leukopenia and thrombocytopenia were 13.4%(9 cases) and 3.0%(2 cases), respectively. Gastrointestinal toxicity was at Grade I or II and 6% patients displayed gastrointestinal toxicity at Grade III/IV. No severe cardiac and hepatorenal functional toxicity was observed.Conclusion: The NAPD regimen for recurrent refractory non-Hodgkin's lymphoma is effective, and its toxicity is well tolerated. It is a salvage chemotherapy regimen and be of worth to be verified.
Objective: To explore the clinical efficacy and toxicity of the NAPD regimen(vinorelbine, cytarabine, cisplatin, and dexamethasone) in the treatment of recurrent refractory non-Hodgkin' s lymphoma.Methods: A total of 67 patients identified with recurrent refractory non-Hodgkin's lymphoma were enrolled for this retrospective study. The curative efficacy of NAPD regimen was evaluated aft er 2 consecutive cycles. The toxicities and side effects were evaluated aft er 1 cycle. The objective response rate(ORR), overall survival(OS), progress free survival(PFS), 1, 2 or 4 years of OS andPFS rates were analyzed. The prognosis was evaluated with univariate and multivariate analysis.Results: The ORR was 53.8% after two cycles, including 5(7.5%) complete responses and 31(46.3%) partial responses. The clinical benefit rate(CBR) was 88.7%(59/67). The median OS was 22(1.5–140.0) months. 1, 2 or 4 years of OS rates were 70.9%, 49.0%, and 35.0%, respectively. The median PFS was 14(1.5–140.0) months; and 1, 2 or 4 years of PFS rates were 57.5%, 38.3%, and 29.8%, respectively. The main side effect was myelosuppression. The rates of Grade III/IV leukopenia and thrombocytopenia were 13.4%(9 cases) and 3.0%(2 cases), respectively. Gastrointestinal toxicity was at Grade I or II and 6% patients displayed gastrointestinal toxicity at Grade III/IV. No severe cardiac and hepatorenal functional toxicity was observed.Conclusion: The NAPD regimen for recurrent refractory non-Hodgkin's lymphoma is effective, and its toxicity is well tolerated. It is a salvage chemotherapy regimen and be of worth to be verified.
引文
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[14]蔡正文,刘汉锋,甘廷庆,等.DHAP方案治疗复发或难治性非霍奇金淋巴瘤的临床观察[J].中外医疗,2009(2):29-30.CAI Zhengwen,LIU Hanfeng,GAN Yanqing,et al.Clinical observation on DHAP regimen in the treatment of relapsed or refractory non-Hodgkin's lymphoma[J].China Foreign Medical Treatment,2009(2):29-30.
[15]李佳,张嵘,胡荣,等.ESHAP方案治疗复发、难治性非霍奇金淋巴瘤疗效观察[J].山东医药,2015,55(15):44-45.LI Jia,ZHANG Rong,HU Rong,et al.Therapeutic effect of ESHAPregimen in the treatment of relapsed and refractory non-Hodgkin's lymphoma[J].Shandong Medial Journal,2015,55(15):44-45.
[16]Velasquez WS,McLaughlin P,Tucker S,et al.ESHAP-an effective chemotherapy regimen in refractory and relapsing lymphoma:a4-year follow-up study[J].J Clin Oncol,1994,12(6):1169-1176.
[17]Yamaguchi M,Kwong YL,Kim WS,et al.Phase II study of SMILEchemotherapy for newly diagnosed stage IV,relapsed,or refractory extranodal natural killer(NK)/T-cell lymphoma,nasal type:the NK-Cell Tumor Study Group study[J].J Clin Oncol,2011,29(33):4410-4416.
[18]范云,黄志煜,罗吕宏,等.GDP方案治疗24例复发、耐药侵袭性非霍奇金淋巴瘤临床分析[J]癌症,2008,27(11):1222-1225.FAN Yun,HUANG Zhiyu,LUO Lühong,et al.Efficacy of GDPregimen(gemcitabine,dexamethasone,and cisplatin)on relapsed or refractory aggressive non-Hodgkin's Lymphoma:a report of 24cases[J].Chinese Journal of Cancer,2008,27(11):1222-1225.
[19]Hutchings M,Loft A,Hansen M,et al.FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma[J].Blood,2006,107(1):52-59.
[20]Cheson BD,Pfistner B,Juweid ME,et al.Revised response criteria for malignant lymphoma[J].J Clin Oncol,2007,25(5):579-586.
[2]Jantunen E,Sureda A.The evolving role of stem cell transplants in lymphomas[J].Biol Blood Marrow Transplant,2012,18(5):660-673.
[3]Chao MP.Treatment challenges in the management of relapsed or refractor y non-Hodgkin’s lymphoma-novel and emerging therapies[J].Cancer Manag Res,2013,5:251-269.
[4]Muller Beissenhirtz H,Kasper C,Nuckel H,et al.Gemcitabine,vinorelbine and prednisone for refractory or relapsed aggressive lymphoma,results of a phase II single center study[J].Ann Hematol,2005,84(12):796-801.
[5]赫文,王文秀,徐玉清,等.长春瑞宾联合方案治疗23例复发性难治性非霍奇金淋巴瘤的临床观察[J].中国肿瘤临床,2007,34(6):353-354.HE Wen,WANG Wenxiu,XU Yuqing,et al.Clinical observation of23 cases of recurrent refractory non-Hodgkin’s lymphoma treated with vinorelbine combined regimen[J].Chinese Journal of Clinical Oncology,2007,34(6):353-354.
[6]黄程辉,吴慧,朱海花,等.NAPD方案治疗复发难治弥漫大B细胞淋巴瘤的疗效[J]中南大学学报(医学版),2018,43(7):754-759.HUANG Chenghui,WU Hui,ZHU Haihua,et al.NAPD regimen for patients with recurrent refractory diffuse large B-cell lymphoma[J].Journal of Central South University.Medical Science,2018,43(7):754-759.
[7]张之南,沈悌.血液病诊断及疗效标准[M].2版.北京:科学出版社,1998:349-360.ZHANG Zhinan,SHEN Ti.Diagnostic and therapeutic criteria for blood disease[M].2nd ed.Beijing:Science Press,1998:349-360.
[8]王冠军.肿瘤学概论[M].北京:人民卫生出版社,2013:271-272.WANG Guanjun.Introduction to oncology[M].Beijing:People’s Medical Publishing House,2013:271-272.
[9]董菲,庞一帆,王晶,等.R±BEACOP方案对预后不良淋巴瘤的疗效研究[J].中南大学学报(医学版),2015,40(8):858-863.DONG Fei,PANG Yifan,WANG Jing,et al.Efficacy of R±BEACOPregimen in patients with poor-prognosis lymphoma[J].Journal of Central South University.Medical Science,2015,40(8):858-863.
[10]鲁明骞,黄慧强,徐光川,等.DHAP方案治疗复发难治性非霍奇金淋巴瘤的临床疗效观察[J].中华肿瘤防治杂志,2006,13(8):624-625.LU Mingqian,HUANG Huiqiang,XU Guangchuan,et al.Clinical study of DHAP regimen for patients with relapsed or refractory in the treatment of advanced non-Hodgkin's lymphoma[J].Chinese Journal of Cancer Preventive Treatment,2006,13(8):624-625.
[11]吴晓雄,李红华,赵瑜,等.ESHAP方案治疗难治性或复发性恶性淋巴瘤的疗效观察[J].临床血液学杂志,2004,17(4):187-188.WU Xiaoxiong,LI Honghua,ZHAO Yu,et al.Effects of ESHAPregimen in treatment of refractor y or relapsing malignant lymphoma[J].Journal of Clinical Hematology,2004,17(4):187-188.
[12]范云,黄志煜,罗吕宏,等.MINE方案治疗复发或耐药的侵袭性淋巴瘤临床观察[J].癌症,2005,24(12):1503-1506.FAN Yun,HUANG Zhiyv,LUO Lühong,et al.MINE regimen for patients with relapsed or chemo-resistant invasive non-Hodgkin’s lymphoma[J].Chinese Journal of Cancer,2005,24(12):1503-1506.
[13]李宇红,姜文奇,黄慧强,等.DHAP方案治疗复发和难治性中、高度恶性非霍奇金淋巴瘤的初步观察[J].癌症,2002,21(8):900-902.LI Yuhong,JIANG Wenqi,HUANG Huiqiang,et al.Prelimary study on DHAP regimen for patients with relapsed and refractory nonHodgkin’s lymphoma[J].Chinese Journal of Cancer,2002,21(8):900-902.
[14]蔡正文,刘汉锋,甘廷庆,等.DHAP方案治疗复发或难治性非霍奇金淋巴瘤的临床观察[J].中外医疗,2009(2):29-30.CAI Zhengwen,LIU Hanfeng,GAN Yanqing,et al.Clinical observation on DHAP regimen in the treatment of relapsed or refractory non-Hodgkin's lymphoma[J].China Foreign Medical Treatment,2009(2):29-30.
[15]李佳,张嵘,胡荣,等.ESHAP方案治疗复发、难治性非霍奇金淋巴瘤疗效观察[J].山东医药,2015,55(15):44-45.LI Jia,ZHANG Rong,HU Rong,et al.Therapeutic effect of ESHAPregimen in the treatment of relapsed and refractory non-Hodgkin's lymphoma[J].Shandong Medial Journal,2015,55(15):44-45.
[16]Velasquez WS,McLaughlin P,Tucker S,et al.ESHAP-an effective chemotherapy regimen in refractory and relapsing lymphoma:a4-year follow-up study[J].J Clin Oncol,1994,12(6):1169-1176.
[17]Yamaguchi M,Kwong YL,Kim WS,et al.Phase II study of SMILEchemotherapy for newly diagnosed stage IV,relapsed,or refractory extranodal natural killer(NK)/T-cell lymphoma,nasal type:the NK-Cell Tumor Study Group study[J].J Clin Oncol,2011,29(33):4410-4416.
[18]范云,黄志煜,罗吕宏,等.GDP方案治疗24例复发、耐药侵袭性非霍奇金淋巴瘤临床分析[J]癌症,2008,27(11):1222-1225.FAN Yun,HUANG Zhiyu,LUO Lühong,et al.Efficacy of GDPregimen(gemcitabine,dexamethasone,and cisplatin)on relapsed or refractory aggressive non-Hodgkin's Lymphoma:a report of 24cases[J].Chinese Journal of Cancer,2008,27(11):1222-1225.
[19]Hutchings M,Loft A,Hansen M,et al.FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma[J].Blood,2006,107(1):52-59.
[20]Cheson BD,Pfistner B,Juweid ME,et al.Revised response criteria for malignant lymphoma[J].J Clin Oncol,2007,25(5):579-586.