CHOP与CHOP-L方案化疗对45例外周T细胞淋巴瘤非特异型疗效及预后分析

CHOP and CHOP-L chemotherapy for nonspecific peripheral T-cell lymphoma

目的：探讨外周T细胞淋巴瘤非特异型CHOP与CHOP-L方案化疗疗效比较及预后因素分析。方法对我院2008年1月至2012年6月经病理及免疫组化诊断明确外周T细胞淋巴瘤非特异型45例患者的临床资料进行回顾性分析。研究近期化疗疗效及影响疗效相关因素及预后分析。结果45例4疗程化疗后疗效：11例CR（16%），20例PR（54%），5例SD（12%），8例PD（18%），总反应率（ORR）为70%。原发耐药（2疗程后未缓解）4例。CHOP方案Ⅰ～Ⅱ度骨髓抑制11例（68.7%），Ⅲ～Ⅳ度5例（31.3%）；CHOP-L方案Ⅰ～Ⅱ度骨髓抑制16例（55%），Ⅲ～Ⅳ度13例（45%）。CHOP-L方案及CHOP方案均有少数患者出现肝功能异常、心脏毒性及胰腺酶异常，但 CHOP-L 方案副反应发生率无明显高于CHOP方案组。化疗疗效与年龄、LDH水平、ECOG、IPI评分、化疗方案及KI-67相关，有统计学意义（P＜0.05）。临床分期、B组症状、LDH水平及IPI评分与患者PFS有关（P＜0.05）。完全缓解患者1年和3年总生存率分别为84.6%、16.1%；部分缓解患者1年OS为50.2%，3年OS为4.4%。多因素分析临床分期（P＜0.05）是本组病例的独立预后因素。结论 PTCL-U 患者常规化疗近期疗效较好，CHOP-L 方案化疗有效率高于CHOP方案，两组不良反应率差异不明显。临床分期是PTCL-U的独立预后因素。

Objective To investigate the comparison and analysis of prognostic factors of effect of special type CHOP and CHOP-L chemotherapy in non-peripheral T cell lymphoma treatment. Methods The clinical data of 45 patients with Peripheral T-cell lymphoma unspecified （PTCL-U） ,which had been diagnosed by pathology and immunohistochemistry, from January 2008 to June 2012 in our hospital were retrospectively analyzed. Results Chemotherapy Curative effect：There are 11 cases of CR （16%）, 20 cases of PR （54%）, 5 cases of SD （12%）, 8 cases of PD （18%）, and 70%ORR, and CHOPⅠ-Ⅱ arrest of bone marrow in 11 cases （68.7%）,Ⅲ-Ⅳ 5 （31.3%）; CHOP-LⅠ-Ⅱ arrest of bone marrow in 16 （55%）, Ⅲ-Ⅳ 13 （45%）. CHOP-L and CHOP scheme both have a small number of patients with abnormal liver function, cardiac toxicity and pancreatic enzyme abnormalities in heart, but CHOP-L scheme’s side reaction rate was not significantly higher than CHOP group. The curative effects of chemotherapy have significant association with age, level of LDH, ECOG, IPI score, chemotherapy options and KI-67 （P〈0.05）. The PFS has statistically significant connection with Clinical staging, B symptom, LDH level and IPI score （P〈0.05）. The survival rates of CR patients for 1 year and 3 years were 84.6%and 16.1%, and the OS of PR patients for 1 years and 3 years were 50.2%and 4.4%. Multi-factors analysis of clinical stage （P〈0.05） were independent prognostic factors in this group of patients. Conclusion Patients with PTCL-U using conventional chemotherapy have good therapeutic effect, CHOP-L is more efficient than CHOP chemotherapy, and adverse reaction rate between the two groups is not significant. Clinical stage was an independent prognostic factor of PTCL-U.