CHOP及高强度方案EPOCH、HyperCVAD、硼替佐米联合化疗治疗外周T细胞淋巴瘤-非特指型的临床效果及预后因素分析

Clinical effect of CHOP and high strength chemotherapy scheme EPOCH,HyperCVAD, Bortezomib combination chemotherapy treating 45 patients with peripheral T cell lymphoma unspecified and prognosis factors

目的探讨不同化疗方案对外周T细胞淋巴瘤-非特指型（PTCL-NOS）患者的近期临床疗效及预后因素。方法回顾性分析安徽省肿瘤医院2009年1月~2012年12月收治的45例PTCL-NOS患者的临床资料。根据患者肿瘤负荷情况、体能状况评分（ECOG）、疾病临床分期情况,采用CHOP及高强度方案[EPOCH、HyperCVAD（A、B方案）及硼替佐米联合化疗]治疗,评价治疗效果及分析预后因素。结果 45例PTCL-NOS患者经治疗后10例完全缓解（22.2%）,25例部分缓解（55.6%）,总有效率为77.8%,第1、2、3年的总生存率分别为84.4%、60.0%、33.3%。45例患者中Ki-67表达〉80%的患者2年生存率小于Ki-67表达≤80%的患者2年生存率,差异有统计学意义（P〈0.05）。中位生存时间25.5个月,单因素分析β2微球蛋白水平、外周T细胞淋巴瘤预后指数（PIT）、骨髓侵犯、临床分期、乳酸脱氢酶水平、体能状况评分与预后生存有关。PIT是PTCL-NOS患者的预后的影响因素,临床分期是影响患者近期疗效的重要因素。结论 PTCL-NOS目前尚无统一的标准方案,对常用的一线方案近期疗效较好,但多数患者很快出现复发、耐药、疾病进展。对于年龄较轻,体能状况评分较好、肿瘤负荷较大的患者建议采用高强度方案组方案和新药的运用争取尽早达到CR,延长总生存时间。

Objective To investigate the clinical effect of CHOP and high strength chemotherapy scheme EPOCH, HyperCVAD, Bortezomib combination chemotherapy treating patients with peripheral T cell lymphoma unspecified （PTCL-NOS） and prognosis factors. Methods From January 2009 to December 2012, in Tumor Hospital of Anhui Province, the data of 45 patiens with PTCL-NOS were analyzed retrospectively. According to the tumor burden of patients, physical status score （ECOG）, clinical stage of disease conditions, these patients were treated with chemotherapy regimens including CHOP and strength chemotherapy scheme [EPOCH, HyperCVAD （A, B program）, Bortezomib combination chemotherapy]. The treament effect and prognostic factors were analyze. Results Among the 45 patiens, complete remisson were 10 cases （22.2%）, partial remission were 25 cases （55.6%） and overall response rate was 77.8%. The 1-year, 2-years, and 3-years overall survival rates were 84.4%, 60.0%, 33.3%respectively. The 2-years overall survival rate of patiens with Ki-67 expression ＆gt;80% was lower than that of patiens with Ki-67 expression≤80%, the difference was statistically significant （P〈 0.05）. Median survival time was 25.5 months. β2-MG, prognosis of peripheral T cell lymphoma index （PIT）, bone marrow infiltration, clinical stage, level of lactate dehydrogenase, ECOG scores were assocoated with prognostic survival. PIT was a influence factor of PTCL-NOS prognosis, the clinical stage was an important factor of influence in the near future effect. Conclusion Because PTCL-NOS has no unified standard regimens, the commonly used a line curative effect is good in the short-term curative effect, but most of the patients appeares soon relapse, drug resistance and disease progression. For the yonger patients, it recommend to use the high strength chemotherapy regimens and the use of new drugs to chieve CR as soon as possible, in order to extend overall survival.