Hyper CVAD/MA与CHOP/CHOP样方案治疗初发外周T细胞淋巴瘤患者疗效分析

Comparative study on the efficacy of Hyper CVAD/MA regimen and CHOP or CHOP like regimen in the treatment of primary peripheral T cell lymphoma

目的 比较Hyper CVAD（大剂量环磷酰胺、表阿霉素、长春地辛、地塞米松）/MA（大剂量甲氨蝶呤、阿糖胞苷）方案与CHOP（环磷酰胺、阿霉素、长春新碱、泼尼松）/CHOP样方案治疗初发外周T细胞淋巴瘤（PTCL）患者的疗效与安全性.方法 回顾性分析80例初发PTCL患者资料,并对接受Hyper CVAD/MA与CHOP/CHOP样方案患者的疗效及不良反应进行比较.结果 80例患者中23例接受Hyper CVAD/MA方案化疗（HM组）,57例接受CHOP/CHOP样方案化疗（CC组）.HM组与CC组患者的总有效率（ORR）（78.3％对54.4％,P=0.047）、IPI评分≤2分患者的ORR率（86.7％对55.2％,P=0.037）、获得缓解所需的化疗疗程数（4个对6个,P=0.004）、中位无进展生存（PFS）时间（24个月对12个月,P=0.039）及1年PFS率（82.6％对45.6％,P=0.006）差异均有统计学意义;而两组患者的复发率相似（50.0％对54.8％,P=0.744）,2年、3年PFS率和3年总生存率差异均无统计学意义（P值均＞0.05）.HM组患者较CC组患者更易发生中性粒细胞减少（＜1.5× 10 9/L者的比例分别为73.9％和38.6％,P=0.004）.结论 Hyper CVAD/MA方案作为诱导方案治疗除ALK阳性外的PTCL患者的近期疗效优于CHOP/CHOP样方案.

Objective To evaluate the curative efficacy and safety of two regimens, Hyper CVAD/ MA and CHOP/CHOP, in the treatment of primary peripheral T cell lymphoma （PTCL）. Methods The clinical data of 80 primary PTCL patients were retrospectively analyzed, and the efficacy and safety of the two regimens, Hyper CVAD/MA and CHOP/CHOP, were evaluated. Results Of 80 patients with primary PTCL, 23 were treated with HyperCVAD/MA regimen （HM group, experimental group） and 57 with CHOP or CHOP-like regimen （CC group, control group）. The differences between overall response rate （ORR） among HM group and CC group （78.3% vs 54.4%, P=-0.047）, ORR in patients with IPI score of 0-2 （86.7% vs 55.2%, P=0.037）, courses of chemotherapy to achieve remission （4 vs 6, P=-0.004）, median progression-free survival （PFS） time （24 months vs 12 months, P--0.039） and 1-year PFS rate （82.6% against 45.6%, P=-0.006） were statistically significant. The relapse rates were similar between 2 groups （50.0% vs 54.8%, P＇=-0.744）. The 2-year and 3-year progression-free survivals and 3 year overall survival were not significantly different （P〉0.05）. Patients in Hyper CVAD/MA group are more susceptible to neutropenia （〈1.5× 109/L） （73.9% vs 38.6%, P=0.004）. Conclusion The curative effect ofHyper CVAD/ MA regimen as induction therapy in treatment of PTCL patients except ALK positive PTCL patients was better than that of CHOP/CHOP-like regimen.