不同化疗方案治疗T细胞淋巴瘤的疗效比较

Curative Effect of Different Chemotherapy Regimens in the Treatment of T Cell Lymphoma

目的探讨不同化疗方案治疗外周T淋巴细胞瘤(peripheral t-cell lymphoma,PTCL)的疗效。方法将2010年8月至2015年1月医院收治的初诊PTCL患者40例,根据用药方案分为2组,CHOP(环磷酰胺+表柔比星+长春新碱+泼尼松)/CHOP样方案作为CC组24例,Hyper CVAD(大剂量环磷酰胺、表柔比星、长春新碱、地塞米松)/MA(大剂量甲氨蝶呤、阿糖胞苷)方案作为HM组16例,记录近期疗效、生存情况、化疗毒副反应,比较化疗前后T淋巴细胞亚群、CD4^+和CD8^+T细胞中CD45RA^+、CD45RO^+T细胞分布情况。结果 HM组缓解率为87.5%高于CC组的54.17%(P<0.05),两组Ⅰ~Ⅱ期化疗缓解率高于Ⅲ~Ⅳ期。两组化疗后CD4^+、CD4^+/CD8^+、CD4^+CD45RO^+均较治疗前升高,且HM组升高幅度较CC组明显(P<0.05);化疗后CD8^+、CD4^+CD45RA^+、CD8^+CD45RA^+、CD8^+CD45RO^+较治疗前下降(P<0.05),其中HM组CD8^+、CD4^+CD45RA^+、CD4^+CD45RO^+下降幅度较CC组明显。HM组中位无进展生存期为25个月长于CC组的12个月(P<0.05),1年无进展生存期几率为81.25%高于CC组的45.83%(P<0.05);两组2年、3年无进展生存期及1年、2年、3年总生存期比较差异无统计学意义(P>0.05)。HM组中性粒细胞减少、血小板减少发生率分别为68.75%、62.5%高于CC组的20.83%、16.67%(P<0.05)。结论 Hyper CVAD/MA治疗初诊PTCL近期疗效好,可延长中位PFS,调节机体免疫功能,但中性粒细胞减少、血小板减少发生率较高,应给予高度重视。

Objective To investigate the curative effect of different chemotherapy regimens in the treatment of peripheral T-cell lymphoma （PTCL）.Methods A total of 40 cases of newly diagnosed PTCL patients admitted to our hospital during August 2010 to January 2015 were divided into two groups according to different regimens.24 cases treated with CHOP （cyclophosphamide ＋ epirubicin ＋ vincristine ＋ prednisone）/CHOP were included into the CC group while 16 cases treated with Hyper CVAD （high-dose cyclophosphamide, epirubicin, vincristine, dexamethasone） / MA （high-dose methotrexate, cytarabine） were included into the HM group.The short-term curative effect, survival and side effects of chemotherapy were recorded.The distribution of T lymphocyte subsets, CD45RA＋ and CD45RO＋ T cells in CD4＋ and CD8＋ T cells was compared before and after chemotherapy.Results The remission rate was higher in HM group than CC group （87.5% vs 54.17%）, higher in phase Ⅰ-Ⅱ than phase Ⅲ-Ⅳ.After chemotherapy, CD4＋, CD4＋/CD8＋ and CD4＋CD45RO＋ in two groups were higher than those before treatment, and the changes were more significant in HM group than CC group （P〈0.05）.After chemotherapy, CD8＋, CD4＋CD45RA＋, CD8＋CD45RA＋ and CD8＋CD45RO＋ were lower than those before treatment, and the changes were more significant in HM group than CC group （P〈0.05）.The progression free survival （PFS） of HM group was longer than CC group （25 months vs 12 months）, and the probability of 1-year FPS was higher in HM group than group CC （81.25% vs 45.83%） （P〈0.05）.There was no significant difference between the two groups in 2-year and 3-year PFS, 1-year, 2-year and 3-year OS （P〉0.05）.The incidence rates of neutropenia and thrombocytopenia were higher in HM group than CC group （68.75%, 62.5% vs 20.83%, 16.67%） （P〈0.05）.Conclusion The short-term curative effect of Hyper CVAD/MA is significant in the treatment of newly diagnosed PTCL.The regimen can prolong the median PFS and regulate the immune function.However, the incidence rates of neutropenia and thrombocytopenia are high, which should be paid high attention to.