DNCE方案治疗复发或难治的侵袭性非霍奇金淋巴瘤

DNCE regimen for treatment of refractory or relapsed aggressive and highly aggressive non-Hodgkin lymphoma

目的探讨DNCE方案作为二线解救方案治疗复发或难治的侵袭性非霍奇金淋巴瘤（NHL）的有效性和安全性。方法经病理学或组织学证实的、且一线CHOP方案治疗后进展的侵袭性恶性NHL患者69例，按信封法随机分为DNCE方案组与DICE方案组。其中DICE组37例，采用地塞米松（DXM）20mg，静脉滴注，d1-d4；异环磷酰胺（IFO）1g／m^2，静脉滴注，d1～d4；Mesna解救400mg，静脉滴注4h，d1～d4；顺铂（DDP）25mg／m^2，静脉滴注，d1～d4；依托泊苷（Vp-16）100mg/m^2，静脉滴注，d1～d4。21～28d为1个周期。DNCE组32例，采用DXM、DDP、Vp-16的剂量与DICE方案相同；NVB25mg/m^2，静脉滴注，d1和d5。21～28d为1个周期。所有患者均完成32个周期的化疗。结果DNCE组中，完全缓解（CR）6例，部分缓解（PR）12例，有效率为56．3％（18／32）；DICE组中，CR4例，PR13例，有效率为45．9％（17／37）。DNCE组的疗效优于DICE组，但两组间差异无统计学意义（P〉0．05）。DICE组的1、3、5年生存率分别为86．5％、58．3％和42．9％，DNCE组分别为87．5％、63．2％和38．5％，两组间差异无统计学意义（P〉0．05）。两组主要的不良反应为骨髓抑制和消化道反应，表现为粒细胞、血小板减少及恶心、呕吐等。DNCE组的骨髓毒性轻于DICE组，差异有统计学意义（P〈0．05）。结论DNCE方案治疗侵袭性NHL的疗效肯定，骨髓毒性较DICE方案为轻，是侵袭性NHL患者安全有效的解救治疗方案。

Objective To evaluate the efficacy and safety of DNCE [ DXM, navelbine （NVB）, DDP and Vp-16 ] regimen and DICE [ dexamethasone （DXM） , ifosfamide （IFO） , cisplatin （DDP） and etoposide （Vp-16）] regimen in the treatment of refractory or relapsed aggressive and highly aggressive non-Hodgkin lymphoma （NHL）. Methods A total of 69 patients with histopathologically proved advanced aggressive and highly aggressive NHL were randomized into trial group （32 patients treated with DNCE regimen） and control group （37 patients treated with DICE regimen ）. The control group was given DICE regimen： DXM 20 mg, iv d1-d4; IFO 1 g/m^2） , iv d1- d4; Mesna 400 mg, iv q8h, d1- d4; DDP 25 mg/m^2, iv d1 - d4 ; Vp-16 100 mg/m^2 , iv d1 - d4 ; one cycle for 21 - 28 days. The trial group was given DNCE regimen ： DXM 20 mg, iv d1 - d4 ; NVB 25 mg/m^2, iv dl and d5 ; DDP 25 mg/m^2, iv d1 - d4 ; Vp- 16 100 mg/m^2, iv d1 - d4; one cycle for 21 -28 days. Each patient completed at least 2 cycles of treatment. Results A better efficacy was shown in the complete response rate, partial response rate, and total response rate between DNCE and DICE groups （ 18.8% vs. 10.8% , 37.5% vs. 35.1% , and 56.3% vs. 45.9%, respectively）, but the differences were statistically non-significant （ P 〉 0.05）. The 1-, 3-, and 5-year survival rates were not significantly increased in DNCE group compared with that in DICE group （86.5% vs. 87.5% , 58.3% vs. 63.2%, 42.9% vs. 38.5% , respectively, P 〉0.05）. The major side effects were leucopenia, thrombocytopenia, and nausea in both groups. The bone marrow depression in DNCE group was significantly slighter than that in the DICE group （ P 〈 0. 05 ）. Conclusion The efficacy of DNCE regimen is as good as DICE regimen, and the bone marrow toxicity is less severe in DNCE group than that in DICE regimen. Therefore, the DNCE regimen is an effective second-line salvage regimen for the treatment of refractory or relapsed aggressive and highly aggressive non-Hodgkin lymphoma.