吡柔比星联合COP四周方案治疗侵袭性非霍奇金淋巴瘤骨髓浸润

Clinical observation of four-weekly pirarubicin combined with COP regimen in aggressive non- Hodgkin lymphoma patients with bone marrow involvement

目的观察吡柔比星（THP）联合COP4周方案（CTOP-28）诱导缓解治疗侵袭性非霍奇金淋巴瘤（NHL）骨髓浸润的近期疗效和患者不良反应。方法回顾性分析2002年1月至2007年1月收治的初治侵袭性NHL骨髓浸润患者65例，比较CHOP3周方案（CHOP-21）和CTOP-28方案的近期疗效和不良反应。CHOP-21方案：环磷酰胺750mg／m^2（第1天）、长春新碱1．4mg／m^2最大量2mg，第1天）、多柔比星50mg／m^2（第1天）、泼尼松100mg（第1天至第5天）；CTOP-28方案：环磷酰胺750mg／m^2（第1、15天）、长春新碱1．4mg／m^2（最大量2mg，第1、8、15、22天）、吡柔比星25mg／m^2第1、2、15、16天）、泼尼松40mg／m^2第1天至第28天）。结果CHOP-21方案组30例完全缓解12例（40％），CTOP-28方案组35例完全缓解28例（80％），后者显著高于前者（P〈0．05）。CTOP-28方案Ⅲ、Ⅳ度血液毒性的发生率（100．0％）显著高于CHOP-21方案（50．0％）（P〈0．05）；CTOP-28方案心脏毒性发生率（8．57％）与CHOP-21方案相当（10．0％）（P〉0．05），均为Ⅰ、Ⅱ度毒性；胃肠毒性和肝肾脏毒性两种方案相当，均为Ⅰ、Ⅱ度；两种方案均未出现治疗相关死亡。结论THP联合COP4周方案是治疗初始侵袭性NHL骨髓浸润的高效、安全的方法。

Objective To evaluate the clinic efficacy and adverse effects of four-weekly pirarubicin combined with COP （CTOP-28） regimen in aggressive non-Hodgkin lymphoma patients with bone marrow involvement. Methods 65 aggressive non-Hodgkin lymphoma cases with bone marrow involvement （BMI） from January 2002 to January 2007 were chosen, who were newly diagnosed according to 2001 World Health Organisition （WHO） classification. The response rate and adverse effects of CTOP-28 regimen were retrospectively compared with standard CHOP-21 regimen in these patients. CHOP-21 regimen： cyclophosphamide 750 mg/m^2（day 1）, vincristine 1.4 mg/m^2 （maximum 2 mg, day 1）, adrimycin 50 mg/m^2 （day 1）, prednisone 100 mg （day 1 to 5）. CTOP-28 regimen： cyclophosphamide 750 mg/m^2 （day 1, 15）, vincristine 1.4 mg/m^2 （maximum 2 mg, day 1,8,15,22）, pirarubicin 25 mg/m^2 （day 1,2 and 15,16）, prednisone 40 mg/m^2 （day 1 to 28）. Results The complete remission rate （CRR） in CHOP-21 group was less than in CTOP-28 group （40 % vs 80 %, P 〈0.05）. The incidence of 3 and 4 degree blood toxicity in CTOP-28 was more than in CHOP-21 （100.0 % vs 50.0 %, P 〈0.05）, but incidence of 1 and 2 degree cardic toxicity was similar as CHOP-21 （8.57 % vs 10.0 %, P 〉0.05） and 3 and 4 degree cardic toxicity did not occurred in both groups. The gastrointestinal, hepatobiliary and renal toxicities at only 1 and 2 degree took place and no difference was found between two groups. No therapy-related mortality occurred in these patients. Conclusion CTOP-28 regimen is more effective, safer for aggressive non-Hodgkin lymphoma patients with BMI as induction treatment.