NAPD方案治疗复发难治弥漫大B细胞淋巴瘤的疗效

NAPD regimen for patients with recurrent refractory diffuse large B-cell lymphoma

目的:探讨NAPD方案(长春瑞滨、阿糖胞苷、顺铂及地塞米松)治疗复发难治性弥漫大B细胞淋巴瘤的疗效和不良反应。方法:30例经一线方案化学治疗(以下简称化疗)后的复发难治弥漫大B细胞淋巴瘤患者被纳入研究。所有患者采用NAPD方案治疗。连续行2个化疗周期后评价疗效,1个周期后评价不良反应,并进行随访。计算客观有效率(objective response rate,ORR)、临床获益率(clinical benefit rate,CBR)、总生存期(overall survival,OS),无进展生存期(progress free survival,PFS)及1,2,4年OS和PFS等,并行单因素分析确定影响因素。结果:2个化疗周期后,ORR为56.7%,CBR为83.3%。其中5例获得完全缓解,12例获得部分缓解,8例获疾病稳定。中位OS 22(1.5~140)个月,1,2,4年OS率分别为59.1%,48.2%和40.2%。中位PFS为14(1.5~140)个月;1,2,4年PFS率分别为56.3%,42.2%和31.7%。不良反应主要为骨髓抑制,分别有3例和1例发生III^IV级白细胞减少和血小板减少,其中1例出现IV度血小板下降后脑出血引起化疗相关性死亡。消化道反应主要为I^II度。无III^IV度心、肝和肾功能损害。结论:NAPD方案对复发难治性弥漫大B细胞淋巴瘤疗效确切,患者对不良反应耐受好,是一个值得进一步验证的挽救性化疗方案。

Objective： To investigate the clinical effi cacy and toxicities for the NAPD regimen （vinorelbine,cytarabine, cisplatin, and dexamethasone） in the treatment of recurrent refractory diff use large B-cell lymphoma. Methods： A total of 30 patients identifi ed with recurrent refractory diff use large B-cell lymphoma were enrolled in this retrospective study. The curative efficacy of NAPD regimen was evaluated after 2 consecutive cycles. The toxicities and adverse reaction were evaluated after 1 cycle. The objective response rate （ORR）, overall survival （OS）, progress free survival （PFS）, and the rates of 1, 2, and 4-year OS and PFS were analyzed. The prognosis was evaluated with univariate analysis. Results： The ORR was 56.7% and clinical benefit rate （CBR） was 83.3% after 2 cycles. Five patients achieved complete remission, 12 achieved partial remission, and 8 achieved stable disease. The median OS was 22 （1.5–140） months. The 1, 2, and 4-year OS rates were 59.1%, 48.2%, and 40.2%, respectively. The median PFS was 14 （1.5–140） months. The 1, 2 and 4-year PFS rates were 56.3%, 42.2%, and 31.7%, respectively. The main adverse reaction was myelosuppression. Three patients suffered from grade III–IV leukopenia and 1 thrombocytopenia. Grade I–II gastrointestinal toxicity was 20%. No heart, liver, and kidney damages at grade III–IV were observed. Conclusion： The NAPD regimen is effective and its toxicity is well tolerated for the treatment of recurrent refractory diffuse large B-cell lymphoma. It is a salvage chemotherapy regimen worth to be verified.