NAPD方案治疗复发难治性非霍奇金淋巴瘤67例临床观察

Clinical observation for NAPD regimen in the treatment of 67 cases of recurrent refractory non-Hodgkin's lymphoma

目的:观察NAPD方案(长春瑞滨、阿糖胞苷、顺铂、地塞米松)治疗复发难治性非霍奇金淋巴瘤的临床疗效和不良反应。方法:67例经一线方案化学药物治疗后的复发难治性非霍奇金淋巴瘤患者采用NAPD方案治疗,连续行2个周期后评价疗效,1个周期后评价不良反应。计算客观有效率(objective response rate,ORR)、临床获益率(clinical benefitrate,CBR)、总生存时间(overallsurvival,OS),无进展生存时间(progressfreesurvival,PFS)及1,2,4年OS及PFS。结果:2个周期化学药物治疗后,ORR为53.8%,其中5例(7.5%)获得完全缓解,31例(46.3%)获得部分缓解, CBR88.1%(59/67)。中位OS 22(1.5～140.0)个月,1,2,4年OS率分别为70.9%,49.0%,35.0%。中位PFS为14(1.5～140.0)个月;1,2,4年PFS率分别为57.5%,38.3%,29.8%。主要不良反应为骨髓抑制。III/IV度白细胞减少及血小板减少发生率分别为13.4%(9例)和3.0%(2例),消化道反应主要为I/II度,III/IV度消化道不良反应发生率为6.0%。无严重的心、肝、肾功能损害。结论:NAPD方案对复发难治性非霍奇金淋巴瘤疗效确切,不良反应较轻,值得进一步验证。

Objective:To explore the clinical efficacy and toxicity of the NAPD regimen(vinorelbine,cytarabine,cisplatin,and dexamethasone)in the treatment of recurrent refractory non-Hodgkin's lymphoma.Methods:A total of 67 patients identified with recurrent refractory non-Hodgkin's lymphoma were enrolled for this retrospective study.The curative efficacy of NAPD regimen was evaluated aft er 2 consecutive cycles.Th e toxicities and side eff ects were evaluated after 1 cycle.The objective response rate(ORR),overall survival(OS),progress free survival(PFS),1,2 or 4 years of OS and PFS rates were analyzed.The prognosis was evaluated with univariate and multivariate analysis.Results:The ORR was 53.8%after two cycles,including 5(7.5%)complete responses and 31(46.3%)partial responses.The clinical benefit rate(CBR)was 88.7%(59/67).The median OS was 22(1.5-140.0)months.1,2 or 4 years of OS rates were 70.9%,49.0%,and 35.0%,respectively.The median PFS was 14(1.5–140.0)months;and 1,2 or 4 years of PFS rates were 57.5%,38.3%,and 29.8%,respectively.The main side effect was myelosuppression.The rates of GradeⅢ/Ⅳleukopenia and thrombocytopenia were 13.4%(9 cases)and 3.0%(2 cases),respectively.Gastrointestinal toxicity was at GradeⅠorⅡand 6%patients displayed gastrointestinal toxicity at GradeⅢ/Ⅳ.No severe cardiac and hepatorenal functional toxicity was observed.Conclusion:The NAPD regimen for recurrent refractory non-Hodgkin’s lymphoma is effective,and its toxicity is well tolerated.It is a salvage chemotherapy regimen and be of worth to be verified.