GCD方案治疗难治或复发性非霍奇金淋巴瘤疗效分析

Efficacy analysis of GCD program in treatment of refractory or relapsed non-Hodgkin's lymphoma

目的：探讨吉西他滨联合顺铂、地塞米松（GDP 方案）治疗侵袭性复发性或难治性非霍奇金淋巴瘤的疗效和毒副作用。方法对2005年7月至2010年8月本院收治的50例复发性或难治性非霍奇金淋巴瘤患者应用 GDP 方案治疗：吉西他滨1000 mg/m^2静脉滴注,d1-8；DDP 25 mg/m^2静脉滴注,d1-3；地塞米松20-40 mg 静脉滴注,d1-3。每3周重复1次。按 WHO 疗效和不良反应评价标准进行疗效和不良反应评价。结果50例患者总有效率（RR）为56%（28/50）,其中难治者 CR 率5.6%（1/18）,RR 率为33.3%（6/18）,复发者 CR 率为37.5%（12/32）,RR 率为59.4%（19/32）,差异有统计学意义（P 〈0.05）。此外,高度侵袭性患者和血清 LDH 高的患者,具有较低的 CR 率和 RR 率（P 〈0.05）。全组中位随访时间36个月（5-51个月）,中位复发时间为7个月（3-34个月）,中位生存时间11个月（3-51个月）,1年和2年总生存率分别35.0%和11.4%。复发 NHL 和难治 NHL 没有显示生存差别（P 〉0.05）。主要不良反应是骨髓抑制,出现Ⅲ度-Ⅳ度的粒细胞和血小板减少的发生率分别为42%和28%。结论GDP 方案治疗复发、耐药侵袭性非霍奇金淋巴瘤是一个有效的、相对低毒的治疗方案,值得临床进一步研究。

Objective To investigate the efficacy and side effects of gemcitabine plus cisplatin, dexamethasone（GDP program）in treatment of recurrent or refractory aggressive non-Hodgkin＇s lymphoma.Methods Fifty patients with relapsed or refractory non-Hodgkin＇s lymphoma from July 2005 to August 2010 in our hospital used GDP regimen：gemcitabine 1000 mg/m^2 intrave-nously,d1-8 ,DDP 25mg/m^2 intravenous infusion,d1-3 ,20 - 40 mg of dexamethasone intrave-nously,d1-3 ,repeated every 3 weeks.Efficacy and adverse reactions according to WHO standards for evaluation of efficacy and adverse reactions were evaluated.Results Total efficiency （RR）in fifty patients was 56%（28/50）,the refractory CR rate was 5.6%（1/18）,RR rate was 33.3%（6/18）,the recurrence CR rate was 37.5%（12/32）,RR rate was 59.4%（1 9/32）,the difference was statistically significant（P 〈0.05）.In addition,highly aggressive patients and high serum LDH patients had a lower CR rate and RR rate（P 〈0.05）.The median follow-up time was 36 months （5-5 1 months）,the median time to recurrence was 7 months（3-34 months）,the median survival time was 1 1 months （3-5 1 months）,1-year and 2-year overall survival rates were 35.0% and 1 1.4%.Relapsed and refractory NHL did not show differences in survival（P =0.261）.The main adverse reactions were myelosuppression,Ⅲ-Ⅳ degree of neutropenia and thrombocytopenia incidence was 42% and 28%,respectively.Conclusion GDP regimen is an effective,relatively low toxicity salvage program in treating relapsed,aggressive non-Hodgkin′s lymphoma and is worthy of further study.