CHOP序贯GDP初始治疗侵袭性非霍奇金淋巴瘤的临床观察-现代医学

CHOP序贯GDP初始治疗侵袭性非霍奇金淋巴瘤的临床观察

单位：西安交通大学医学院附属陕西省肿瘤医院肿瘤内科, 陕西西安 710061

关键词：非霍奇金淋巴瘤弥漫大B细胞淋巴瘤外周T细胞淋巴瘤 CHOP方案 GDP方案

分类号：R733

出版年·卷·期（页码）：2019·47·第三期（245-250）

摘要：

目的：评价"CHOP序贯GDP"方案治疗侵袭性非霍奇金淋巴瘤的有效性与安全性。方法：将93例侵袭性非霍奇金淋巴瘤患者随机分为试验组（n=47）与对照组（n=46），试验组化疗方案采用"3周期一线CHOP-21方案后序贯3周期二线GDP-21方案"，对照组采用"6周期CHOP-21方案"；局限期（Ⅰ~Ⅱ期）结内、结外淋巴瘤患者在化疗6周期结束后进行受累野放射治疗。采用CT及骨髓穿刺评价近期和远期疗效，并评估不良反应。结果：客观缓解率试验组和对照组分别为63.83%和56.52%，疾病控制率试验组和对照组分别为80.85%，69.55%，两组差异均无统计学意义（P>0.05）；5年的总生存期试验组55.32%、对照组34.78%，无病生存期试验组38.89%、对照组6.67%，5年无疾病进展生存期试验组29.79%、对照组4.35%，两组差异均有统计学意义（P<0.05）。两组不良反应主要表现在骨髓抑制（中性粒细胞、血小板减少）和胃肠道反应，差异无统计学意义（P>0.05）；无一例严重不良事件发生。结论：一线CHOP-21方案后序贯二线GDP-21方案远期疗效优于一线CHOP-21方案，近期疗效及不良反应两者无显著差异。

Objective:To evaluate the efficacy and safety of the "CHOP sequential GDP" regimen in the treatment of invasive non Hodgkin lymphoma. Methods:93 patients with invasive non Hodgkin lymphoma were randomly divided into experimental group(n=47) and control group(n=46). The experimental group received 3 cycles of the first-line CHOP-21 regimen and 3 cycles of the second-line GDP-21 regimen, while the control group adopted the 6 cycles CHOP-21 plan. Localized and extranodal lymphoma patients at the limited period(Ⅰ-Ⅱ phase) underwent radiation therapy after the end of chemotherapy 6 cycles. CT and bone marrow aspiration were used to evaluate the shor/long-term effects and the adverse effects.Results:The ORR and DCR in the experimental group and the control group were 63.83% and 56.52%, 80.85% and 69.55%, respectively, and which were not statistically different(P>0.05). 5 years of OS in the experimental group andcontrol groupwere 55.32% and 34.78%, DFS in the experimental group andcontrol group were 38.89% and 6.67%, PFS in the experimental group and control group were 29.79% and 4.35%, which had significant differences(P<0.05). The adverse reactions were mainly manifested bone marrow suppression(neutrophils, thrombocytopenia) and gastrointestinal reactions, there were no significant differencesbetween the two groups(P>0.05), and the serious adverse events didn't occur. Conclusion:The long term effect of the sequential second-line GDP-21 regimen after the first-line CHOP-21 regimen is better than that of the first line CHOP-21, and there are no significant differences in the short term effect and adverse reaction between the two groups.

参考文献：

[1] SIEGEL R L,MILLER K D,JEMAL A.Cancer statistics, 2018[J].CA Cancer J Clin,2018,68(1):7-30.
[2] CHEN W Q,ZHENG R S,BAADE P D,et al.Cancer statistics in China, 2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3] 李岩,刘爱春.弥漫大B细胞淋巴瘤预后相关因素研究进展[J].东南大学学报(医学版),2017,36(4):666-670.
[4] ZHOU Z,SEHN L H,RADEMAKER A W,et al.An enhanced international prognostic index(NCCN-IPI)for patients with diffuse large B-cell lymphoma treated in the rituximab era[J].Blood,2014,123:837-842.
[5] AL-HAMADANI M,HABERMANN T M,CERHAN J R,et al.Non-Hodgkin lymphoma subtype distribution, geodemographic patterns, and survival in the US:a longitudinal analysis of the National Cancer Data Base from 1998 to 2011[J].Am J Hematol,2015,90(9):790-795.
[6] LI X Q,LI G D,GAO Z F,et al.The relative frequencies of lymphoma subtypes in China:a nationwide study of 10002 cases by the Chinese Lymphoma Study Group[J].Ann Oncol,2011,22(Suppl 4):141.
[7] 麻亮亮,袁进,向兵,等.236例弥漫大B细胞淋巴瘤患者临床特点及预后因素分析[J].中华血液学杂志,2012,33(9):768-770.
[8] 陈施婧.(R)-CHOP方案治疗弥漫大B细胞淋巴瘤患者过程中的相关因素与治疗反应及预后关系的分析[D].镇江:江苏大学,2015.
[9] ENGLAND C G,RUI L,CAI W,et al.Lymphoma:current status of clinical and preclinical imaging with radiolabeled antibodies[J].Eur J Nucl Med Mol Imaging,2017,44(3):517-532.
[10] CRUMP M.Management of relapsed diffuse large B-cell lymphoma[J].Hematol Oncol Clin North Am,2016,30(6):1195-1213.
[11] CRUMP M,LEPPA S,FAVAD L,et al.Randomized, double-blind, phase Ⅲ trial of enzastaurin versus placebo in patients achieving remission after first-line therapy for high-risk diffuse large B-Cell lymphoma[J].J Clin Oncol,2016,34(21):2484-2492.
[12] DAVISON K,CHEN B E,KUDRETI V,et al.Treatment outcomes for older patients with relapsed/refractory aggressive lymphoma receiving salvage chemotherapy and autologous stem cell transplantation are similar to younger patients:a subgroup analysis from the phase Ⅲ CCTG LY.12 trial[J].Ann Oncol,2017,28(3):622-627.
[13] SANGHA R,DAVIES A,DANG N H,et al.Phase 1 study of inotuzumab ozogamicin combined with R-GDP for the treatment of patients with relapsed/refractory CD22⁺ B-cell non-Hodgkin lymphoma[J].J Drug Assess,2017,6(1):10-17.
[14] SKAMENE T,CRUMP M,SAVAGE K J,et al.Salvage chemotherapy and autologous stem cell transplantation for peripheral T-cell lymphoma:a subset analysis of the Canadian Cancer Trials Group LY.12 randomized phase 3 study[J].Leuk Lymphoma,2017,58(10):2319-2327.
[15] QI F,DONG M,HE X,et al.Gemcitabine, dexamethasone, and cisplatin (GDP) as salvage chemotherapy for patients with relapsed or refractory peripheral T cell lymphoma-not otherwise specified[J].Ann Hematol,2017,96(2):245-251.
[16] MOCCIA A A,HITZ F,HOSKINS P,et al.Gemcitabine, dexamethasone, and cisplatin (GDP) is an effective and well-tolerated salvage therapy for relapsed/refractory diffuse large B-cell lymphoma and Hodgkin lymphoma[J].Leuk Lymphoma,2017,58(2):324-332.
[17] AOTA Y,TANAKA M,WATANABE N,et al.Outpatient re-induction therapy with gemcitabine, dexamethasone, Cisplatin (GDP) for patients with relapsed and refractory lymphoma[J].Gan To Kagaku Ryoho,2015,42(1):51-55.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录