CHOP联合口服VP-16方案与CHOP方案治疗具有不良预后因素的非霍奇金淋巴瘤临床比较

Clinical Comparison of CHOP Plus Oral VP-16 Regimen and CHOP Regimen for Adverse Prognostic Factor Non-Hodgkin's Lymphoma

目的 比较CHOP联合口服VP 16方案和CHOP标准方案治疗具有不良预后因素的中、高度恶性非霍奇金淋巴瘤 (NHL)的临床疗效和毒性。方法 选择NHL国际预后指数 (IPI)为高中度、高度危险组的中、高度恶性NHL 72例 ,随机分为强化方案及标准方案两组 ,分别采用上述两方案治疗。结果 两组CR率分别为 6 7.6 % (2 5 / 37)和 4 5 .7% (16 / 35 ) ,无显著差异 (P >0 .0 5 ) ,但强化方案组二年生存率和二年无病生存率分别为 5 9.5 % (2 2 / 37)和 4 3.2 % (16 / 37) ,明显优于标准方案组的 34.3% (12 / 35 )、2 0 .0 % (7/ 35 ) ,差异显著 (P <0 .0 5 )。毒副反应方面 ,强化方案组WBC降低发生率高于标准方案组(χ2 =4 .6 7,P <0 .0 5 ) ,其中Ⅲ～Ⅳ度WBC降低及PLT降低均明显高于标准方案组 (P <0 .0 1) ,因WBC降低发热亦明显多见 (χ2 =4 .6 6 ,P <0 .0 5 )。两组给药的相对剂量强度分别为 93.7%和 96 .6 %。结论 强化方案对具有不良预后因素的中、高度NHL有较好的疗效 ,临床可行。

Objective Comparison the clinical results of CHOP plus oral VP-16 regimen and standard CHOP regimen for the treatment of intermediate or high grade Non-Hodgkin's lymphoma(NHL) with adverse prognostic factor.Methods 72 cases of pathologically proved intermediate or high grade NHL patients in international prognostic index (IPI) high-intermediate risk and high risk groups were enrolled and randomly treated with CHOP regimen plus oral VP-16 capsule(intensive regimen group)or CHOP regimen(Standard regimen group).Results Complete response rates were (67.6%)(25/37) and (45.7%)(16/35), respectively. There were no statistically significant difference between the two groups (P>(0.05)). But two-year OS and two-year DFS of intensive regimen group were (59.5%) (22/37) and (43.2%)(16/37), respectively. Superior over (34.3%) (12/35), 20.0(7/35) for standard regimen group (P<(0.05)). About the side effects, leukopenia of intensive regimen was more serious than standard regimen (P<(0.01)),especially for Ⅲ～Ⅳ leukopenia and thrombocytopenia(P<0.01). and the incidence of related fever from leukopenia of intensive regimen was higher than standard regimen too (χ~2=(4.66),P<(0.05)). The relative dose intensity of two groups was (93.7%) and 96.6%, respectively.Conclusion CHOP plus oral VP-16 intensive regimen had superior therapeutic efficacy over standard CHOP regimen for intermediate or high grade Non-Hodgkin's lymphoma(NHL) with adverse prognostic factor and was feasible in clinical status.