含左旋门冬酰胺酶的联合化疗方案治疗外周T细胞淋巴瘤的临床观察

A clinical observation of treatment of peripheral T-cell lymphoma with L-asparaginase-containing combination chemotherapy

目的 观察含左旋门冬酰胺酶（L-ASP）的联合化疗方案治疗初发外周T细胞淋巴瘤的疗效和不良反应.方法 回顾性分析浙江大学医学院附属第一医院2012年1月至2013年12月接受含L-ASP与不含L-ASP的联合化疗方案治疗的初发外周T细胞淋巴瘤102例,前者（含L-ASP组）42例,后者（不含L-ASP组）60例,比较两组的近期疗效如完全缓解（CR）率、部分缓解（PR）率和总有效（OR）率,以及远期疗效如总生存（OS）率、无进展生存（PFS）率及不良反应.结果 含L-ASP组的OR率明显高于不含L-ASP组[83.3％（35/42）比61.7％ （37/60）,P=0.016],其中在分期为Ⅲ/Ⅳ期[82.4％（28/34）比54.0％（27/50）,P=0.007]和国际预后指数（IPI）评分≥2分[82.1％（23/28）比50.0％ （21/42）,P=0.006]的患者中尤其明显.含L-ASP组的3年OS率为48.9％,不含L-ASP组为65.0％,差异无统计学意义（P=0.974）;含L-ASP组的3年PFS率为40.8％,不含L-ASP组为61.0％,差异也无统计学意义（P=0.479）.含L-ASP组虽然不良反应较不含L-ASP组多,但多为轻度,经对症支持治疗后均可好转,Ⅲ～Ⅳ度中性粒细胞减少引起的严重发热两组无明显差异（P=0.777）,含L-ASP组其他严重不良反应如脑出血、急性胰腺炎均只发生1例.结论 含L-ASP的联合化疗方案治疗初发外周T细胞淋巴瘤显示了较好的近期疗效,且不良反应可控.L-ASP用于一线治疗外周T细胞淋巴瘤的大型前瞻性临床试验值得开展和深入研究.

Objective To investigate the efficacy and adverse effects of L-asparaginase （L-ASP） containing regimens in patients with newly diagnosed peripheral T-cell lymphoma.Methods A total of 102 newly diagnosed patients with peripheral T-cell lymphoma who received combination chemotherapy with or without L-ASP were enrolled in the study between January 2011 and December 2013 in our hospital.Therapeutic and adverse effects were retrospectively analyzed,including the short-term efficacy such as complete remission （CR） rate,partial remission （PR） rate,overall remission （OR） rate,and long-term efficacy such as overall survival（OS） rate,progressive free survival（PFS） rate.Results The OR rate in patients treated with L-ASP containing regimens （L-ASP group） was apparently higher than the patients treated without L-ASP （non L-ASP group） [83.3% （35/42） vs 61.7% （37/60）,P =0.016].Furthermore,the difference was especially significant in patients with stage Ⅲ/Ⅳ [82.4% （28/34） vs 54.0%（27/50）,P=0.007] or IPI seore≥2 [82.1%（23/28） vs50.0%（21/42）,P=0.006].The 3-year OS rate of L-ASP group and non L-ASP group were 48.9% and 65.0% respectively（P =0.974）.Three-year PFS rate of L-ASP group and non L-ASP group were 40.8% and 61.0% respectively （P =0.479）.Neither had statistical significance.Although the incidence of adverse effects was higher in L-ASP group,most of them were mild and controllable after supportive treatment.There was no significant difference in serious infections caused by Ⅲ-Ⅳ degree neutropenia between the two groups （P =0.777）.Other severe side-effects in L-ASP group such as hematencephalon and acute pancreatitis were only seen in one case respectively.Conclusions Combination chemotherapy with L-ASP showed better short-term efficacy in newly diagnosed peripheral T-cell lymphoma patients and the adverse effects were controllable.Large scale prospective clinical trial of using L-ASP in peripheral T-cell lymphoma is worthy of developing and further studying.