氟达拉滨联合化疗治疗初治滤泡型淋巴瘤的临床观察

Efficacy and safety of fludarabine-based combination chemotherapy in patients with previously untreated follicular non-Hodgkin's lymphoma

目的:评价氟达拉滨联合化疗治疗初治滤泡型淋巴瘤的疗效和不良反应。方法:研究对象为本院确诊的30例初治滤泡型淋巴瘤患者,其中17例接受FC(氟达拉滨+环磷酰胺)方案治疗,13例接受R-FC(利妥昔单抗+氟达拉滨+环磷酰胺)方案治疗。所有患者均接受2～6个周期的化疗,中位化疗周期数为4.5个周期。结果:30例患者中达完全缓解者26例(86.7%),部分缓解者1例(3.3%),总有效率为90.0%。在各项临床因素中,只有Ki-67表达阳性率对完全缓解有明显影响(P=0.031)。全部30例患者的1、2、3和4年无进展生存率分别为90%、85%、85%和63%。单因素分析发现,国际预后指数评分、Ki-67阳性率、血清乳酸脱氢酶及能否获得完全缓解对无进展生存的影响有统计学意义(P<0.05)。主要不良反应为骨髓抑制、免疫抑制和轻度胃肠道反应。有51.0%的化疗周期发生白细胞计数下降,10.5%的化疗周期发生血小板减少,33.0%的化疗周期发生胃肠反应。全组患者的带状疱疹发生率为30.0%,其中R-FC组的带状疱疹发生率为46.2%,FC组的带状疱疹发生率为17.6%。结论:氟达拉滨为主的联合化疗方案治疗初治滤泡型淋巴瘤的临床缓解率较高,无病生存时间较长,且不良反应可以耐受。

Objective： To evaluate the efficacy and safety of fludarabine-based combination chemotherapy in patients with previously untreated follicular non-Hodgkin＇s lymphoma. Methods： Thirty patients with previously untreated follicular non-Hodgkin＇s lymphoma were enrolled into this study. Seventeen of 30 patients received FC regimen （fludarabine plus cyclophosphamide）, and 13 received rituximab （R）-FC regimen. The average number of chemotherapy cycles was 4.5 （range： 2-6）. Results： Of thirty patients, twenty-six （86.7%） achieved complete remission （CR） and 1 （3.3%） achieved partial remission （PR）. The overall response rate was 90.0%. Ki-67 proliferation index was the only predictive factor associated with CR （P=0.031） among many clinicopathological factors. One-, two-, three- and four-year progressive-free survival （PFS） rates were 90%, 85%, 85% and 63%, respectively. Univariate analysis showed that the international prognostic index, positive expression rate of Ki-67, serum lactate dehydrogenase level and achieving complete remission had significant effects on PFS （P〈O.05）. The major adverse effects were myelosuppression, immunosuppression and mild gastrointestinal toxicity. The incidence rates of leucopenia, thrombocytopenia and nausea/vomiting were 51.0%, 10.5% and 33.0%, respectively. Nine patients （30.0%） developed herpes zoster infection after chemotherapy, with an incidence rate of 46.2% （6/13） in R-FC group and 17.6% （3/17） in FC group. Conclusion： Fludarabine- based chemotherapy regimen exerts good therapeutic effects on patients with previously untreated follicular non-Hodgkin＇s lymphoma, and it is well-tolerated.