HLH-2004与COP方案治疗继发性噬血细胞性淋巴组织细胞增多症患者疗效比较

The HLH-2004 versus COP chemotherapy in patients with secondary hemophagocytic lymphohistiocytosis

目的:比较HLH-2004与COP方案治疗继发性噬血细胞性淋巴组织细胞增多症(sHLH)患者疗效与不良反应。方法:38例sHLH患者随机分入HLH-2004与COP组,HLH-2004组18例,COP组20例,比较2组疗效与不良反应。结果:HLH-2004组完全缓解(CR)率38.9%,总体反应(RR)率72.2%;COP组CR率45%,RR率80%,2组差异无统计学意义(P>0.05)。对患者进行病因分析,2组差异无统计学意义(P>0.05)。HLH-2004组白细胞下降发生率Ⅲ～Ⅳ度为61.1%、血小板下降发生率Ⅲ～Ⅳ度为83.3%,均明显高于COP组的15%、25%,差异有统计学意义(P<0.05),而2组间的感染发生率比较差异无统计学意义。HLH-2004组患者中位生存时间62(12～186)周,1年OS率55.6%;COP组患者中位生存时间55(2～204)周,1年OS率68.6%,2组差异无统计学意义(P>0.05)。结论:COP方案治疗sHLH患者疗效与HLH-2004相当,但不良反应相对较少,对于无法耐受较大剂量化疗的患者,COP方案是一个良好的选择。

Objective：The goal of this study was to compare the effectiveness and side effects of HLH-2004 and COP chemotherapy in treating patients with secondary hemophagocytic lymphohistiocytosis. Method：thirty-eight patients in our hospital were randomized into HLH-2004 or COP group.（HLH-2004 group 18 patients COP group 20 patients） Result：Complete remission（CR） rate was 38.9% and response rate（RR） was 72.2% in HLH-2004 group and CR rate 45%,RR 80% in COP group,respectively（both P0.05）.There was no difference of different etiologic factors between the two group.There was no difference in infection rates,but the occurrence of grade 3/4 Leukopenia（61.1%） and of grade 3/4 Thrombocytopenia（83.3%） in HLH-2004 group were significantly higher than that in COP group（15%,25%）（P0.05）.The median survival time was 62（12-186） weeks and one year overall survival（OS） rate was 55.6% in HLH-2004 group and median survival time 55（2-204） weeks,one year OS 68.6% in COP group,respectively（both P0.05）. Conclusion：COP regimen has similar effectiveness to HLH-2004 regimen in sHLH patients,but less side effects.For the patients who are unable to tolerate higher doses of chemotherapy,COP regimen is a good choice.