摘要
目的评估程序性死亡受体1(PD-1)抑制剂联合放疗治疗晚期及复发/难治性结外NK/T细胞淋巴瘤(ENKTL)的临床疗效和安全性。方法回顾性分析2019年1月至2021年12月中山大学肿瘤防治中心收治的26例晚期及复发/难治性ENKTL患者的资料。患者采用PD-1抑制剂联合放疗方案进行治疗,分析该方案的疗效、生存情况及不良反应。采用Kaplan-Meier法估算1、2年的无进展生存(PFS)率及总生存(OS)率,采用Cox比例风险模型对PFS、OS进行预后影响因素的单因素分析。结果26例患者中位随访时间为29(范围10~49)个月,客观缓解率为85%,其中完全缓解率是77%、部分缓解率是8%,中位PFS期为25个月,1、2年PFS率分别为73.1%、53.3%,1、2年OS率分别为88.5%、75.3%。主要不良反应为急性放射性黏膜炎,发生率为31%(8/26例),其次为血液学不良反应,免疫性肺、肝、甲状腺损伤发生率低。1例患者出现3级急性放射性黏膜炎,1例患者出现4级免疫性肺炎,其余均为1、2级不良反应,患者耐受性良好。单因素分析显示,乳酸脱氢酶升高、治疗后EB病毒DNA阳性、抗PD-1免疫治疗周期数不超过6个周期为OS的不良预后因素。结论PD-1抑制剂联合放疗对晚期及复发/难治性ENKTL患者疗效显著且耐受性良好。
Objective To assess the efficacy and safety of programmed death-1(PD-1)inhibitor combined with radiotherapy in advanced and relapsed/refractory extranodal NK/T cell lymphoma(ENKTL).Methods Clinical data of 26 patients with advanced and recurrent/refractory ENKTL admitted to Sun Yat-sen University Cancer Center from January 2019 to December 2021 were retrospectively analyzed.All patients were treated with the PD-1 inhibitor combined with radiotherapy.The treatment responses,survival rate and and adverse reactions of the regimen were analyzed.The Kaplan-Meier method was used to estimate the 1-and 2-year progression-free survival(PFS)rate and overall survival(OS)rate,and the Cox proportional risk model was used for univariate prognostic factorial analysis for PFS and OS.Results The median follow-up time of 26 patients was 29 months(10-49 months).The objective response rate(ORR)was 85%.The complete and partial remission rates were 77%and 8%.The median PFS time was 25 months.The 1-and 2-year PFS rates were 73.1%and 53.3%.The 1-and 2-year OS rates were 88.5%and 75.3%.The main adverse reaction was acute mucositis with an incidence rate of 31%(8/26),followed by hematological toxicity.The incidence of immune-related adverse events in lung,liver and thyroid were low.Only 1 patient developed grade 3 acute mucositis,1 patient developed grade 4 immune pneumonitis,and the remaining patients had grade 1-2 toxicities.All patients showed good tolerance.The univariate analysis showed that elevated lactate dehydrogenase,Epstein-Barr virus DNA positive after treatment,and less than 6 cycles of anti-PD-1 immunotherapy were prognostic factors for poor OS.Conclusion The regimen of PD-1 inhibitor combined with radiotherapy demonstrates promising efficacy and well tolerance in patients with advanced and relapsed/refractory ENKTL.
作者
刘媛
谢文跃
李泉
王汉渝
夏云飞
张玉晶
Liu Yuan;Xie Wenyue;Li Quan;Wang Hanyu;Xia Yunfei;Zhang Yujing(Department of Oncology,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Science,Xiangyang 441000,China;Department of Radiation Oncology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Guangzhou 510060,China;Department of Oncology,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2024年第5期426-431,共6页
Chinese Journal of Radiation Oncology
基金
襄阳市科技研究与开发项目(2021ZD04)。
