摘要
【目的】探索持续灌注EPOCH方案一线治疗NK/T细胞淋巴瘤(NK/TCL)的近期疗效、远期生存和不良反应。【方法】2003年6月至2008年6月间,共收治NK/TCL34例,其中原发鼻腔或鼻咽30例(88.2%),鼻型4例(11.8%)。全组一线EPOCH化疗1～6个疗程(中位疗程数2.5个)。病灶局限的鼻NK/TCL患者,化疗后加用侵犯野放疗。【结果】34例患者中33例可评价疗效,总有效率60.6%(20/33),完全缓解率(CR率)45.5%(15/33)。鼻NK/TCL总有效率66.7%(20/30),CR率50%(15/30);鼻型NK/TCL仅1例稳定(SD),余2例均在化疗中病情恶化(PD)。中位随访22(2～68)个月后,全组预计3年总生存率(OS)为52.2%。鼻NK/TCL患者的预计中位生存时间未达到,3年OS为59.4%;而鼻型患者预计中位生存时间仅7个月。对Ⅰ～Ⅱ期鼻NK/TCL患者,一线EPOCH化疗序贯侵犯野放疗的CR率为75%,3年OS为75%。主要不良反应为骨髓抑制,Ⅲ～Ⅳ度粒细胞减少占30.9%,无治疗相关死亡。【结论】EPOCH方案对鼻NK/TCL有较好的疗效,耐受性好,对病灶局限的患者,一线EPOCH化疗联合侵犯野放疗在近期疗效和远期生存均令人满意。对鼻型NK/T淋巴瘤效果似乎较差,亟需寻找新的有效治疗方案。
【Objective】 This study was aimed to evaluate treatment outcomes and toxicity of continuous-infusion EPOCH regimen for NK/T-cell lymphoma （NK/TCL）. 【Methods】 From June 2003 to June 2008, 34 patients including 30 nasal NK/TCL （88.2%） and 4 nasal type NK/TCL （11.8% ） received doxorubicin, vincristine, etoposide over 96 hours infusion with bolus cyclophosphamide and oral predinisone （EPOCH） chemotherapy as first-line treatment. Median cycles of EPOCH administered were 2.5 （1-6 cycles）. Additional involved field radiation therapy （IFRT） was administered to patients with localized nasal focus after chemotherapy. 【Results】 Among 34 patients, 33 were eligible for response evaluation. The response rate （RR） was 60.6% （20/33） with complete remission （CR） rate of 45.5% （15/33）. The RR of patients with nasal NK/TCL was 66.7% （20/30） with CR rate of 50% （15/30）. Only one of the 3 nasal type NK/TCL patients achieved stable disease （SD）, the other 2 had progressive disease （PD） during chemotherapy. After a median follow-up of 22 （2-68） months, the estimated 3-year overall survival rate （OS） was 52.2%. For patients with nasal NK/TCL, the estimated median survival time was not reached, the 3-year OS was 59.4%. For patients with nasal type NK/TCL, the estimated median survival time was only 7 months. The CR rate was 75.0% for localized nasal NK/TCL who received initial EPOCH chemotherapy followed IFRT with the 3-year OS of 75.0%. Major adverse effect was myelosuppression. The incidence of grade Ⅲ-Ⅳ neutropenia was 30.9% . No treatment-related mortality occurred. 【Conclusions】 EPOCH regiment was effective and well tolerant for nasal NK/TCL. Combined EPOCH chemotherapy followed by IFRT produced promising outcome for patients with localized disease. However, patients with nasal type NK/TCL responded poorly and more efficacious treatment strategies are urgently needed.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2010年第2期274-277,共4页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省自然科学基金(6021356)
