DICE方案治疗复发或耐药中高度恶性非霍奇金淋巴瘤

Treatment Effect of DICE Regimen on Patients with Relapsed or Refractory Intermediate and High Grade Non-Hodgkin's Lymphoma

背景与目的:复发或耐药非霍奇金淋巴瘤(non鄄Hodgkin蒺slymphoma,NHL)目前尚无标准的解救化疗方案,DICE、ESHAP、MINE和EPOCH等常见的解救治疗方案缓解率仅为30%～70%。本文旨在观察DICE方案作为解救化疗方案治疗复发或耐药中高度恶性NHL的疗效和安全性。方法:选取35例复发或耐药的中高度恶性NHL患者,其中T细胞和B细胞NHL分别为14和21例,既往接受过以CHOP或CHOP样方案为主中位6周期(2～12个周期)的化疗,采用DICE方案进行解救治疗。结果:35例患者接受了中位4周期(2～7个周期)的DICE方案化疗,所有患者均可评价疗效和不良反应。总的客观有效率为74.3%,完全缓解率为31.4%;中位缓解时间为4个月(1～30个月),中位至治疗失败时间为7个月(2～34个月),中位生存期为14个月(3～51个月),实际2年生存率为33.3%。T细胞和B细胞NHL的有效率分别为85.7%(12/14)和66.7%(14/21),完全缓解率分别为50.0%(7/14)和19.0%(4/21)(P=0.073)。LDH升高和伴有巨大肿块是影响解救治疗疗效的高危因素(P<0.05),DICE解救疗效是复发耐药患者生存期的独立预后因素(P=0.001)。主要不良反应为骨髓抑制,Ⅲ～Ⅳ度粒细胞和血小板减少的发生率分别为71.4%和8.6%。结论:DICE方案是复发或耐药中高度恶性NHL安全有效的解救治疗方案。LDH升高和伴有巨大?

BACKGROUND & OBJECTIVE: So far, there is still no standard salvage r egimen for relapsed or refractory non-Hodgkin's lymphoma (NHL). The response rat es (RR) of NHL patients received common salvage regimens, such as DICE, ESHAP, M INE, and EPOCH, are only 30%-70%. This study was to evaluate the efficacy and sa fety of DICE regimen, as a salvage regimen, in treating patients with relapsed o r refractory intermediate and high grade NHL. METHODS: Thirty-five patients with relapsed or refractory intermediate and high grade NHL, who had been pretreated with chemotherapy dominated by CHOP or CHOP-like regimen with a median of 6 cyc les (ranged 2-12 cycles), were salvaged by DICE regimen from Jun. 1999 to Jan. 2 004. Of the 35 patients, 14 were T-cell original, and 21 were B-cell original. R ESULTS: The 35 patients received DICE regimen with a median of 4 cycles (ranged 2-7 cycles). All patients were assessable in the efficacy and adverse events. Th e total RR was 74.3% with complete response (CR) rate of 31.4%, median response time (MST) of 4 months (ranged 1-30 months), median time to failure (TTF) of 7 m onths (ranged 2-34 months),median survival time (MST) of 14 months (ranged 3-51 months), and 2-year survival rate of 33.3%. The RRs of T-cell and B-cell NHL wer e 85.7% and 66.7%. The CR rate was higher in T-cells NHL than in B-cell NHL (50. 0% vs. 19.0%, P=0.073). Elevated serum lactate dehydrogenase (LDH) and bulky dis ease were high risk factors of the efficacy of DICE regimen (P < 0.05). The resp onse to DICE reginmen was an independent prognostic factor of patients with rela psed or refractory NHL (P = 0.001). The major toxicity was myelosuppression. Inc idences of neutropenia and thrombocytopenia of grade Ⅲ-Ⅳ were 71.4% and 8.6%. CONCLUSIONS: DICE regimen is a safe and effective salvage regimen for the patien ts with relapsed or refractory intermediate and high grade advanced NHL. Elevate d serum LDH and bulky disease are the adverse prognostic factors. The response t o DICE regimen may directly influence survival time of patients with relapsed or refractory NHL.