GDP方案治疗24例复发、耐药侵袭性非霍奇金淋巴瘤临床分析

Efficacy of GDP Regimen(Gemcitabine,Dexamethasone,and Cisplatin) on Relapsed or Refractory Aggressive Non-Hodgkin's Lymphoma:A Report of 24 Cases

背景与目的:复发、耐药侵袭性非霍奇金淋巴瘤(non-Hodgkin’slymphoma,NHL)的预后仍较差,寻找高效、低毒的挽救方案一直是研究的目标。吉西他滨单药治疗淋巴瘤有效,与顺铂联合对一些实体瘤有很好的疗效。本研究评价吉西他滨联合顺铂及地塞米松组成的GDP方案治疗复发、耐药侵袭性NHL的疗效及毒副反应。方法:24例复发或耐药的侵袭性NHL均具有可测量的病灶,均接受过至少一种方案化疗。GDP方案:吉西他滨1000mg/m2静脉滴注,d1,8;DDP25mg/m2静脉滴注,d1～3;地塞米松20～40mg静脉滴注,d1～3。每3周重复1次。按WHO疗效和不良反应评价标准进行疗效和不良反应评价。结果:24例患者共完成76个周期化疗,均可评价疗效和不良反应。完全缓解5例,部分缓解9例,8例稳定,2例进展。完全缓解率20.8%,总缓解率58.3%;B细胞NHL和T细胞NHL的缓解率分别为57.1%和60.0%,差异无统计学意义(P=0.889)。全组中位随访1.2年,总1年生存率41.7%,B细胞NHL和T细胞NHL的1年生存率分别为42.9%和40.0%,差异无统计学意义(P=0.986)。Ⅲ～Ⅳ度白细胞减少、血小板减少及血红蛋白减少的发生率分别为16.7%、37.5%及25.0%,非血液学不良反应较轻微。无治疗相关死亡。2例患者挽救化疗后进行了干细胞移植,干细胞动员效果未受影响。结论:GDP方案治疗复发、耐药侵袭性NHL是一个有效的、相对低毒的挽救方案,值得临床进一步研究。

BACKGROUND ＆ OBJECTIVE. The prognosis of relapsed or refractory aggressive non-Hodgkin＇s lymphoma （NHL） after front-line therapy remains poor. The development of more effective and less toxic salvage regimens remains a major challenge. Gemcitabine is effective in treating lymphoma and, when combined with cisplatin, is effective for some solid tumors. This study was to evaluate the efficacy of GDP regimen （gemcitabine, dexamethasone, and cisplatin） on relapsed or refractory aggressive NHL, and observe the adverse events. METHODS. Patients with relapsed or refractory aggressive NHL, measurable disease, and had received previously at least one chemotherapy regimen were enrolled and treated with GDP regimen （gemcitabine 1000 mg/m2 on Days 1 and 8, dexamethasone 20-40 mg on Days 1-3, and cisplatin 25 mg/m2 on Days 1-3） every 3 weeks. The efficacy and adverse events were evaluated according to the WHO criteria. RESULTS： Twenty-four patients had received a total of 76 chemotherapy cycles, and were assessable for efficacy and adverse events. Five （20.8%） patients had complete response, 9 had partial response, 8 had stable disease, and 2 had progressive disease. The overall response rate （RR） was 58.3% for assessable patients; it was 57.1% for B- cell NHL patients and 60.0% for T-cell NHL patients （P=0.889）. The median follow-up was 1.2 years. The 1-year overall survival rate was 41.7%; it was 42.9% in B-cell NHL patients and 40.0% in T-cell NHL patients （P=0.986）. The occurrence rate was 37.5% for grade Ⅲ-Ⅳ leucopenia, 25.0% for thrombocytopenia, and 16.7% for anemia in all patients. Non-hematologic toxicities were mild. There was no treatment-related death. Two patients proceeded to stem cell transplantation after salvage chemotherapy and obtained sufficient stem cells. CONCLUSION： GDP regimen is an effective and relatively nontoxic salvage chemotherapy regimen for relapsed or refractory aggressive NHL.