CVDLP与CHOP方案治疗Ⅲ/Ⅳ期淋巴母细胞性淋巴瘤诱导缓解期疗效比较

Comparing CVDLP with CHOP in Induction Treatment for Patients with Advanced Lymphoblastic Lymphoma

目的：探讨早期强烈诱导缓解方案提高晚期淋巴母细胞性淋巴瘤的完全缓解 (complete remission,CR)率。方法： 11例Ⅲ /Ⅳ期初治淋巴母细胞性淋巴瘤，诱导缓解期接受 CVDLP方案化疗：环磷酰胺 1000 mg/m2 d1，长春新碱 1.5 mg/m2 d1、 d8、 d15、 d21,阿霉素 40 mg/m2 d1、 d2、 d21，门冬酰胺酶 10 000 U/m2 d15～ 24，强的松 60 mg/m2 d1～ 28，第 15天逐步减量。氨甲喋呤加阿糖胞苷鞘内注射每周一次，共 4次。第 28～ 33天评价疗效。同时回顾性比较 9例初治Ⅲ /Ⅳ期淋巴母细胞性淋巴瘤，采用标准 CHOP方案治疗两疗程后的疗效（第 35天）。结果： CVDLP方案组 10例初治病人获得完全缓解 , 1例病人获得部分缓解 ,完全缓解率达 90.9％ ;10例病人出现Ⅳ级血液毒性， 1例病人出现Ⅲ级血液毒性（ WHO标准）。 CHOP组 3例完全缓解， 5例部分缓解， 1例微效 ,完全缓解率达 33％ ;3例病人出现Ⅲ级血液毒性， 6例病人出现Ⅱ级血液毒性。结论：对于晚期淋巴母细胞瘤，诱导缓解期采用 CVDLP方案获得的早期完全缓解率明显高于 CHOP方案，血液毒性也比 CHOP大，但加强支持疗法，此诱导缓解方案安全可行。

Objective: This study was designed to improve complete remission(CR) rate in the patients with advanced lymphoblastic lymphoma by using early extensive induction chemotherapy. Method:A total of 11 cases of untreated lymphoblastic lymphoma in StageⅢ /Ⅳ were received CVDLP regimen, including cytoxan(CTX) 1000 mg/m2 d1， vincristine(VCR) 1.5 mg/m2 d1,d8,d15,d21， Adriamycin(ADR) 40 mg/m2 d1， d2， d21， L- asparaginase(L- ASP) 10000 U/m2 d15～ 24， Prednison 60 mg/m2 d1～ 28， gradually decreased dosage at d15. methotrexate＋ Ara- C IT qw× 4. Efficacy were evaluated at d28～ 35. Simultaneously,retrospective analysis for 9 cases of untreated lymphoblastic lymphoma in StageⅢ /Ⅳ treated with 2 cycles of CHOP were made. Efficacy were evaluated at d35. Results: CVDLP group: 10/11 cases of patients achieved CR, and 1/11 case had PR, rate of complete remission was 90.9％ ; 10/11 cases had GradeⅣ hematological toxicity,1/11 cases had GradeⅢ hematological toxicity(WHO). CHOP group:3/9 got CR;5/9 got PR;1/9 had MR,rate of complete remission was 33％ . 3/9 had GradeⅢ hematology toxicity; 6/9 had GradeⅡ hematological toxicity. Conclusion:CVDLP regimen can induce higher CR rate than CHOP regimen in untreated lymphoblastic lymphoma with StageⅢ /Ⅳ , but hematology toxicity was also higher than CHOP regimen. However this induction regimen is safe and viable with strengthening supportive care.