CTOP与CHOP方案治疗外周T细胞淋巴瘤的疗效比较

Comparison of Therapeutic Effects of CTOP and CHOP Regimen on Unspecified Peripheral T-cell Lymphoma

目的:比较含吡喃阿霉素(THP)的CTOP方案与含阿霉素(ADM)的CHOP方案治疗外周T细胞性非霍奇金氏淋巴瘤-非特异性(PTCL-U)的疗效和不良反应。方法:采用两种方案治疗PTCL-U患者共130例,THP组49例,ADM组81例。结果:两组患者临床特征指标相似(P>0.05)。可评价疗效129例,两组有效率分别为71.6%和72.8%,CR率分别为43.2%和39.5%(P>0.05)。骨髓抑制、胃肠道反应、脱发为主要不良反应。Ⅲ～Ⅳ度白细胞降低、血小板和血红蛋白降低发生率两组无明显差异;脱发ADM组高于THP组(31.1%:14.0%,P<0.001);ADM组心脏毒性稍高于THP组(11.1%%:6.1%,P=0.522)。中位随访24个月(1～88个月),两组预计5年生存率分别为22.0%和42.2%(P<0.01)。结论:采用含THP的CTOP方案治疗PTCL-U疗效较好,毒性较低,远期生存率较高,值得临床进一步研究。

Objective： To compare the efficacy and toxicity of CTOP （with THP） and CHOP in the treatment of unspecified peripheral T-cell lymphoma （PTCL-U）. Methods： One hundred and thirty patients with PTCL-U were treated with combined chemotherapy, including CTOP and CHOP, from January 1997 to December 2003 in the Cancer Center, among which 49 were treated by CTOP and 81 by CHOP regimen. The rate of response, toxicity and long-term survival for the two regimens were analyzed retrospectively. Results： The clinical characteristics of the two groups were similar （P〉0.05）. A total of 129 patients were eligible. The response rate for CHOP and CTOP was 71.6% and 72.8%, respectively （P〉0.05） and the CR rate was 43.2% and 39.5%, respectively （P〉0.05）. Major toxicity was myelosuppression, GI toxicity and alopecia. There was no difference between the two groups in grade Ⅲ～Ⅱ toxicity in neutropenia, thrombocytopenia and anemia. Incidence of alopecia was higher in the CHOP group （31.1% vs. 14.0%, P=0.000）. Although cardiotoxicity was high in CHOP group （11.1% vs. 6.1%）, no statistical difference between the two groups was confirmed （P=0.522）. Median follow-up was 24 months （ranged from 1 to 88 months）. The 5-year overall survival rate for CHOP and CTOP group was 22.0% and 44.2%, respectively （P〈0.01）. Conclusions： THP in the CTOP regimen may be more effective on PTCL-U with lower toxicity and better long term survival. Randomized clinical trial is warranted.