CVAD方案治疗复发性非霍奇金淋巴瘤疗效观察

Efficacy of CBP, VM-26, Ara-C, DXM combination therapy for relapsed non-Hodgkin's lymphoma

目的 观察卡铂(CBP)、替尼泊苷(VM-26)、阿糖胞苷(Ara-C)和地塞米松(DXM)组成的CVAD方案治疗复发性非霍奇金淋巴瘤的临床疗效和毒性反应。方法 24例经正规CHOP方案治疗后复发的非霍奇金淋巴瘤患者,采用CVAD方案化疗。第1～5 d,静脉滴注C8P 60 mg·m～2·d～1、VM-26 60 mg·m～2·d～1、Ara—C 400 mg·m-2·d～1、DXM 10 mg·m -2·d～1,其中Ara—C和DXM分二次滴注。间隔3～4周,同一方案再行一次。结果 完成二个疗程后,完全缓解13例(54.2％),部分缓解8例(33.3％),进展3例,总有效率87.5％;中位生存期16个月。所有病例都出现造血功能抑制,但能恢复。按WHO判断标准,非血液系统毒性均表现为Ⅱ级以下,无尿素氮和肌酐增高。结论 CVAD方案治疗复发性非霍奇金淋巴瘤有效且毒性可耐受,尤其对多次使用CHOP的患者,可避免蒽琨类药物对心脏的毒性。

Objective To evaluate the efficacy and toxicity of carboplatin (CBP) , teniposide (VM-26) , cytara-bine ( Ara-C) and dexamethason (DXM) combination therapy (CVAD regimen) for relapsed non-Hodgkin's lympho-ma ( NHL) . Methods Twenty-four patients were diagnosed NHL clinically and pathologically. All cases received first-line chemotherapy, such as CHOP, BCHOP, and CHOPE etc. We treated the patients with CBP 60·mg·m-2· d - 1, VM-26 60 mg· m-2 · d-1 , Ara-C 400 mg · m -2 · d -1 and DXM 10 mg · m-2 · d-1 with 1 - 5 d duration and the same regimen was repeated for more then two cycles after every 28 d. Results Among these patients the response rate ( CR + PR) was 87. 5% (21/24) , including 13 (54. 2% ) CR and 8 (33. 3% ) PR. The median survival duration was 16 months. One year survival in the relapsed cases was 58. 3% . The major toxic effect was myelosuppres-sion, and 91. 7% of the patients had grade Ⅲ-Ⅳ neutropenia. Twenty-one patients (87. 5% ) developed grade Ⅲ-Ⅳ thrombocytopenia. Severe mucositis, diarrhea and emesis were uncommon. Regimen-related death was not observed. Conclusion CVAD regimen is an effective and salvage therapy for treatment of relapsed NHL. The major dose-limiting toxicity is myelosuppression.