HyperCVAD／HDMTX—L方案挽救治疗弥漫大B细胞淋巴瘤的临床观察

Clinical observation of HyperCVAD/HDMTX-L regimen as salvage treatment for patients with diffuse large B-cell lymphoma

目的评价HyperCVAD／HDMTX-L方案作为弥漫大B细胞淋巴瘤挽救方案的疗效及安全性。方法回顾性分析采用HyperCVAD／HDMTX—L方案挽救治疗54例弥漫大B细胞淋巴瘤患者的疗效及不良反应，分为CHOP或类CHOP方案治疗无效组27例和治疗后复发组24例，分别以HyperCVAD／MA方案治疗无效组22例和治疗后复发组26例为对照，比较两个方案治疗4个周期的疗效、不良反应和3年无进展生存（PFS）率。结果HyperCVAD／HDMTX-L在CHOP或类CHOP方案无效组有效率59．3％（16／27），3年PFS率73．3％，HyperCVAD／MA组有效率61．9％（13／21），3年PFS率61．5％，两组有效率、PFS率差异均无统计学意义（均P〉0．05）；HyperCVAD／HDMTX．L在CHOP或类CHOP方案治疗后复发组有效率47．8％（11／23），3年PFS率54．5％，HyperCVAD／MA组有效率45．5％（10／22），3年PFS率50．0％，两组有效率、PFS率差异均无统计学意义（均P〉0．05）。HyperCVAD／HDMTX—L组化疗相关的恶心、呕吐、白细胞减少、血小板减少、出血的发生率均低于对照组（均P〈0．001）。结论HyperCVAD／HDMTX-L方案可替代HyperCVAD／MA方案作为弥漫大B细胞淋巴瘤的挽救方案。

Objective To evaluate the efficacy and safety of HyperCVAD/HDMTX-L regimen as salvage treatment for patients with diffuse large B-cell lymphoma. Methods A retrospective study was made to analyze the efficacy and adverse reaction of HyperCVAD/HDMTX-L regimen as salvage treatment for 54 patients with diffuse large B-cell lymphoma. 27 cases were divided in CHOP class scheme ineffective group, 24 cases in recurrence group, HyperCVAD/MA regimen were as the control group. The efficacy in the treatment of 4 cycles, side effects of all cycles and 3-year progression free survival rates of the two regimens were compared. Results In CHOP class scheme ineffective group, efficiency rate of HyperCVAD/HDMTX-L was 59.3 % （16/27）, 3y PFS rate was 73.3 %, efficiency rate of HyperCVAD/MA was 61.9 % （13/21）, 3y PFS rate was 61.5 %. There was no significant difference in efficiency and PFS rate between the two groups （P 〉 t,05）. In recurrence group, efficiency rate of HyperCVAD/HDMTX-L was 47.8 % （11/23）, 3y PFS rate was 54.5 %, efficiency rate of HyperCVAD/MA was 45.5 % （10/22）, 3y PFS rate was 50.0 %, there was no significant difference in efficiency and PFS rate between the two groups （P 〉 0.05）. The incidence rates of nausea and vomiting, aleukocytosis, thrombocytopenia, hemorrhage associated with chemotherapy in HyperCVAD/HDMTX-L group were significantly lower than those in the control group （all P 〈 0.001）. Conclusion HyperCVAD/HDMTX-L regimen maybe replace HyperCVAD/MA as the salvage treatment of diffuse large B-cell lymphoma.