硼替佐米联合EPOCH治疗复发难治性非霍奇金淋巴瘤

Bortezomib-EPOCH in Patients with Relapsed or Refractory Non-Hodgkin's Lymphoma

目的观察硼替佐米（万科）联合EPOCH化疗作为复发或难治性非霍奇金淋巴瘤（NHL）治疗方案的疗效及安全性。方法回顾性分析30例复发或难治性NHL患者。采用万珂联合EPOCH化疗作为治疗方案，观察患者疗效、不良反应及近期生存情况。结果30例患者各接受2-4个周期该联合治疗方案，总客观有效率（OR）为53．4％，其中5例（16．7％）获得完全缓解（CR）。研究还显示有B症状患者较无B症状患者对该联合化疗方案的反应差（OR分别为20％VS33．3％，P〈0．05）；高乳酸脱氢酶LDH患者较正常LDH患者疗效差（OR分别为6．7％VS46．7％，P〈0．01）；骨髓有无受侵犯、β2-MG是否增高、年龄、肿瘤细胞来源及ECOG（东部肿瘤协作组）评分的OR比较无在统计学差异。患者中位无病生存时间PFS为10个月，95％可信区间为6．18％-13．82％。主要不良反应有骨髓抑制伴轻微感染、周围神经性毒性、胃肠道反应，但均可耐受。结论万珂联合EP-OCH化疗治疗方案有较好的治疗效果及较高的安全性，我们认为该联合化疗可以作为治疗复发或难治性NHL安全有效的治疗方案之一，并值得进一步深入的临床研究。

Objective To assess the efficacy and safety of bortezomib plus EPOCH regimen for patients with relapsed or refractory non - Hodgkin＇s lymphoma（ NHL）. Methods The clinical data of thirty patients with relapsed or refractory NHL were analysed retrospec- tively. They were offered treatment with bortezomib -EPOCH combination chemotherapy[ bortezomib （1.3mg/m2, intravenous injection for3-5 seconds, days 1, 4, 8, 11, 21 for one course of treatment], VP16（5Omg/m2, days 1 -4）, doxorubicine（lOmg/m2, days 1 - 5 ）, vincristine（0.4mg/m2, days 1 - 4）, cyclophosphamide （750mg/m2, days 5 ） and prednisone [ 40mg/（ m2 · d） ]. The response and toxicities of this regimen were evaluated. Results Five patients （ 16.7% ） and eleven patients （ 36.7% ） achieved complete remission （CR） and partly remission（PR） , respectively, following one or two courses of bortezomib - EPOCH, and the overall response（OR） rate was 53.4%. The median disease- free survival（DFS） was 10 months（95% CI：6. 18% -13.82% ）. It demonstrated a significantly higher response in patients without B symptoms （ OR ： 20% vs 33.3%, P 〈 O. 05 ） and normal LDH （ OR ： 6.7% vs 46.7%, P 〈 0.01 ） compared with B symptoms and higher LDH, respectively. There were no significant differences for OR between the patients in the follow- ing groups, with and without bone marrow invasion, normal and higher β2 - MG, more than 60 years and less than 60 years, T and B cell originated, ECOG 0 - 1 and ECOG 2 - 3. Hematological toxicity, infections, neuropathy and digestive reaction were the major toxicities of this regimen. Toxicities were comparable and were mostly of grades 1 and 2. Conclusion The bortezomib - EPOCH regimen possesses good efficacy, acceptable toxicity. This protocol is worthy to be applied and researched as salvage treatment for patients with relapsed or refractory NHL.