化疗联合干扰素治疗成人T细胞白血病/淋巴瘤28例分析

Analysis of 28 patients with adult T-cell leukemia/lymphoma treated with various regimens

目的评价化疗联合干扰素治疗成人T细胞白血病/淋巴瘤(ATLL)的临床疗效,探讨ATLL可行的治疗方法。方法回顾分析28例ATLL患者的临床特征及不同诊治方案的疗效,其中4例用重组人α-2b干扰素治疗,8例用重组人α-2b干扰素联合CHOP方案治疗,6例用CHOP方案化疗,7例用EPOCH方案化疗,3例患者拒绝化疗,只接受对症处理。比较不同组患者治疗前后症状、血常规、血清乳酸脱氢酶、C反应蛋白、血沉、β2微球蛋白、Ki-67阳性率及生存时间等变化情况。能耐受化疗患者均行2个疗程及以上。结果中位随访时间13个月,接受重组人α-2b干扰素治疗有效的3例,1例进展;接受重组人α-2b干扰素联合CHOP方案化疗有效的7例,1例进展;使用CHOP方案化疗有效的3例,进展2例,死亡1例;使用EPOCH方案有效的4例,2例进展,死亡1例;拒绝治疗患者死亡2例,进展1例。化疗联合干扰素治疗组的有效率高于单用化疗组及单用干扰素组,差异有统计学意义(P <0.05),其中位无进展生存时间(PFS)和总生存时间(OS)高于单纯化疗组,差异均有统计学意义(P <0.05)。化疗联合干扰素治疗组的PFS高于单用干扰素组(P <0.05),而OS无差异(P>0.05)。单用干扰素组的OS和PFS优于单纯化疗组(P<0.05)。结论化疗联合干扰素治疗可作为ATLL的治疗选择,其可在一定程度上延缓疾病进展。

Objective To evaluate the clinical outcome of chemotherapy and interferon in adult T-cell leukemia/lymphoma(ATLL) patients, and to discuss the feasible treatment in ATLL patients. Methods The clinical characteristics and the effect of different treatments in 28 ATLL patients were retrospectively analyzed. 4 patients were treated with reorganized alpha-2b interferon. 8 patients were treated with reorganized alpha-2b interferon and CHOP therapy. 6 patients were treated with CHOP therapy. 7 patients were treated with EPOCH therapy. The other 3 patients refused chemotherapy and accepted the supportive treatments. The changes of symptom, hematological parameters, lactate dehydrogenase, C-reactive protein, erythrocyte sedimentation rate, β2-microglobulin, the positive rate of Ki-67 and survival times in different groups of patients before and after treatments were compared. Receiving chemotherapy patients were treated for 2 courses and more. Results The median follow up time was 13 months, 3 patients had good effect of treating with α-2b interferon, and 1 patient had disease progression. 7 patients responded well of treating with α-2b interferon and CHOP therapy, and 1 patient had disease progression. 3 patients had good effect of treating with CHOP therapy, 2 patients had disease progression and 1 patient died. 4 patients had good effect of treating with EPOCH therapy, 2 patients had disease progression and 1 patient died. 2 patients refused chemotherapy and died, and the other 1 patient refused treatment and had disease progression. The overall response rate in group with α-2b interferon and CHOP therapy was obviously higher in group with chemotherapy or α-2b interferon alone(P < 0.05). The median PFS and OS for patients treated with α-2b interferon and CHOP therapy were obviously higher than chemotherapy alone, and there were significant differences(P < 0.05). The PFS in group with α-2b interferon and CHOP therapy was higher than interferon alone(P < 0.05), but there was no significant difference between the OS(P > 0.05). The OS and PFS in interferon alone were better than those treated with chemotherapy alone(P < 0.05). Conclusions Chemotherapy and interferon are suitable for ATLL to delay the disease progression in part.