以吉西他滨为主方案和以蒽环类药物为主方案治疗外周T细胞淋巴瘤效果比较

Efficacy comparison of gemcitabine-based and anthracycline-based chemotherapy regimens in unspecified peripheral T-cell lymphoma

目的比较以吉西他滨为主方案和以蒽环类药物为主方案一线治疗外周T细胞淋巴瘤-非特指型（PTCL—U）的疗效和安全性。方法对37例符合入组条件的PTCL．U患者资料进行回顾性分析。采用以吉西他滨为主方案化疗（试验组）17例，采用以蒽环类药物为主方案化疗（对照组）20例。对两组的近期客观疗效、疾病进展、总生存以及不良反应情况进行分析比较。结果试验组和对照组总有效率分别为88．2％（15／17）和55．0％（11／20），完全缓解率分别为76．5％（13／17）和40．0％（8／20），差异均有统计学意义（均P〈0．05）。按PTCL—U预后指数（PIT）进行危险因素亚组分层分析，低危组中，两组的客观疗效差异无统计学意义（19〉0．05）；高危组中，试验组7例患者完全缓解5例，对照组8例患者完全缓解仅1例，前者疗效明显高于后者（P〈0．05）。试验组和对照组的中位无进展生存期分别为10．1个月和53个月，中位总生存期分别为193个月和12．4个月，差异均有统计学意义（均P〈0．05）。主要不良反应均为骨髓抑制、胃肠道反应、脱发、心脏毒性，试验组Ⅰ～Ⅱ度血小板减少发生率高于对照组（P〈0．05），脱发和心脏毒性发生率低于对照组（P〈0．05）。全组患者无化疗相关性死亡。结论以吉西他滨为主化疗方案一线治疗PTCL—U疗效较好，优于以蒽环类药物为主方案，且不良反应可耐受，值得临床进一步研究。

Objective To compare the efficacy and toxicity of gemcitabine-based and anthracycline- based chemotherapy regimens in the treatment of peripheral T-cell lymphoma unspecified （PTCL-U）. Methods The data of 37 eligible patients with PTCL-U were analyzed retrospectively. The patients were classified into two groups： trial group including 17 patients treated with gemcitabine-based regimen, and control group including 20 patients treated with anthracyeline-based regimen. The response rate （RR）, time to progression （TFP）, overall survival （OS） and toxicity were assessed. Results RR and complete response rate （CR） were significantly higher in the trial group than those in the control group [88.2 % （15/17） vs 55.0 % （11/20）, 76.5 % （13/17） vs 40.0 % （8/20）, P 〈 0.05]. Among the patients with high （PTCL-U） prognostic index （PIT） score, 5 cases achieved CR of 7 patients in the trial group and 1 case of 8 patients in control group （P 〈 0.05）. There was no significant difference in the RR between the two groups among the patients with low PIT score （P 〉 0.05）. The median TTP was significantly longer in the trial group than that in the control group （10.1 months vs 5.3 months, P 〈 0.05）. The median OS in the trial group was longer than that in the control group （19.3 months vs 12.4 months, P 〈 0.05）. Major toxicity reactions included myelosuppression, gastrointestinal reaction, alopecia and cardiotoxicity. The incidence of thromboeytopenia （grade I - II ） in the trial group was significantly higher than that in the control group （P 〈 0.05）. The incidences of alopeeia and eardiotoxieity in the trial group were significantly lower than those in the control group （P 〈 0.05）. No chemotherapy-related death occurred. Conclusion Gemeitahine-based chemotherapy regimens may be more effective for PTCL-U than anthracyeline-based chemotherapy regimens, and it can be well tolerated, which requires further clinical study.