Hyper-CVAD方案治疗高度侵袭性非霍奇金淋巴瘤的疗效分析

The Therapeutic Efficacy of Hyper-CVAD Regimen on High-aggressive Non-Hodgkin' s Lymphoma

目的:观察Hyper-CVAD化疗方案治疗高度侵袭性非霍奇金淋巴瘤的治疗效果。方法:47例高度恶性NHL患者,其中T母细胞淋巴瘤39例和Burkitt's淋巴瘤8例。所有患者接受Hyper-CVAD化疗方案治疗6个周期-8个周期。根据中枢神经系统复发情况,给予氨甲喋呤和阿糖胞苷进行鞘内治疗(IT)4次-16次。对早期患者(受累区域)和有大肿块或者有残留灶的晚期患者给予30Gy-40Gy的剂量常规放疗。结果:中位随访时间36个月(12个月-53个月),所有患者接受了平均6.8个周期化疗(总共319个周期),41例(87.2%)取得完全缓解(CR);26例患者无病生存,中位生存时间34个月(3个月-51个月),中位复发时间为9月(3个月-23个月),1年无病生存率与总生存率分别为81.0%和91.4%,3年为53.2%和57.4%。高龄、IPI指数高和伴有大肿块、骨髓受侵犯、B症状,晚期患者具有较低的CR率和较差的预后。接受鞘内治疗后中枢神经系统(CNS)复发率10.6%。主要不良反应为骨髓抑制,Ⅲ度-Ⅳ度白细胞和血小板减少的发生率分别为100%和36.2%。结论:Hyper-CVAD方案治疗配合鞘内化疗与局部放疗是治疗高度侵袭性NHL的有效的方案,具有较高的缓解率和3年生存率。

Objective： To evaluate the efficacy and safety of hyper-CVAD regimen in Chinese patients with high-aggressive Non-Hodgkin＇ s Lymphoma. Methods： Patients with high-grade NHL（47 cases） ,T-cell lymphoblastic lymphoma （39 cases） and Burkett＇ s lymphoma （8 eases） were treated by Hyper-CVAD regimen for 6-8 cycles. Ara-C or MTX was alternately given by intrathecal therapy （IT） for 4-16 times according to the danger levels of CNS recurrence. Radiation, with total dose 30Gy-40Gy through routine radiation method, was given to early patients for involved field and to advanced patients for bulky or residual focus. The therapeutic efficacy and adverse effect were observed. Results： The median follow-up time was 36 months （ranged 12-53 months）. All these patients received hyper-CVAD regimen with a mean of 6.8 cycles （total 319 cycles）. 41 patients （87.2%） got complete response （CR） and 26 patients disease-free survival at present. The median time to failure was 9 months （ranged 3-23 months） ,and the median survival time was 34 months （ranged 3-51 months）. The disease-free survival rate and overall survival rate in 1-year were 81.0% and 91. 4% respectively, and those in 3-year were 53.2% and 57.4% respectively. There were poor prognosis and lower CR rate for elderly, highly international prognosis index（ IPI）, bulky, B system, and advanced stage patients. The recurrence rate of central neural system was 10.6 percent of all patients received intrathecal therapy. The major adverse reaction was the toxicity of borrow. The borrow toxicity of leukopenia and platelet reduction in Ⅲ-Ⅳ level were 100% and 36.2% respectively. Conclusion： Hyper-CVAD regimen combining with IT and radiotherapy is an effective regimen for the patients with high-aggressive NHL, which has a high CR rate and 3-year survival rate.