CAJ | 학술논문

[目的]探讨DHAOx方案(地塞米松、大剂量阿糖胞苷、奥沙利铂)治疗复发和难治性非霍奇金淋巴瘤(NHL)的近期疗效和不良反应.[方法]中山大学肿瘤防治中心近年采用DHAOx±R方案(地塞米松20 mg/d静脉滴注d1～4;阿糖胞苷2 000 mg/m~2 3 h静脉滴注,12 h重复一次d2:奥沙利铂130 mg/m~2 2 h静脉滴注d1:加或不加抗CD20单克隆抗体利妥昔单抗375 mg/m~2,d0)治疗20例复发和难治性NHL患者,其中6例缓解后接受了自体外周血造血干细胞移植支持下的超大剂量化疗.客观疗效评定参照1998年美国和罔际淋巴瘤专家组制定的NHL疗效评价标准,分为完全缓解(CR),部分缓解(PR),稳定(SD)和疾病进展(PD);不良反应评价按照WHO不良反应评价标准分为0-Ⅳ度.[结果]20例患者共化疗47疗程,接受DHAOx方案13例(65%),DHAOx+R方案7例(35%),20例均可评价疗效,总有效率55%(11/20),完全缓解率(CR)35%(7/20),既往接受过含铂类方案的患者再次接受DHAOx±R方案亦有效.主要的不良反应为骨髓抑制,主要表现为中性粒细胞下降和血小板下降,Ⅲ～Ⅳ级的中性粒细胞下降占35%(16/47).其中村细胞缺乏合并感染性发热占17%(8/47);Ⅲ～Ⅳ级的血小板下降占20%(9/47);轻度的外周神经毒性占17%(8/47).中位随访12个月(1～32个月),1年和2年生存率均为70.6%.[结论]DHAOx治疗复发难治NHL有效率与传统DHAP方案(地塞米松、大剂量阿糖胞苷、顺铂)相似,不良反应可耐受,值得在更大宗病例中作进一步的研究.
[목적]탐토DHAOx방안(지새미송、대제량아당포감、오사리박)치료복발화난치성비곽기금림파류(NHL)적근기료효화불량반응.[방법]중산대학종류방치중심근년채용DHAOx±R방안(지새미송20 mg/d정맥적주d1～4;아당포감2 000 mg/m~2 3 h정맥적주,12 h중복일차d2:오사리박130 mg/m~2 2 h정맥적주d1:가혹불가항CD20단극륭항체리타석단항375 mg/m~2,d0)치료20례복발화난치성NHL환자,기중6례완해후접수료자체외주혈조혈간세포이식지지하적초대제양화료.객관료효평정삼조1998년미국화망제림파류전가조제정적NHL료효평개표준,분위완전완해(CR),부분완해(PR),은정(SD)화질병진전(PD);불량반응평개안조WHO불량반응평개표준분위0-Ⅳ도.[결과]20례환자공화료47료정,접수DHAOx방안13례(65%),DHAOx+R방안7례(35%),20례균가평개료효,총유효솔55%(11/20),완전완해솔(CR)35%(7/20),기왕접수과함박류방안적환자재차접수DHAOx±R방안역유효.주요적불량반응위골수억제,주요표현위중성립세포하강화혈소판하강,Ⅲ～Ⅳ급적중성립세포하강점35%(16/47).기중촌세포결핍합병감염성발열점17%(8/47);Ⅲ～Ⅳ급적혈소판하강점20%(9/47);경도적외주신경독성점17%(8/47).중위수방12개월(1～32개월),1년화2년생존솔균위70.6%.[결론]DHAOx치료복발난치NHL유효솔여전통DHAP방안(지새미송、대제량아당포감、순박)상사,불량반응가내수,치득재경대종병례중작진일보적연구.
[Objective]To evaluate the clinical efficacy and side effects of DHAOx±R regimen in the patients with relapsed and refractory non-Hodgkin's lymphoma(NHL).[Methods]Twenty patients with relapsed or refractory NHL were enrolled into this study in Cancer Center of Sun Yat-sen University.These patients were treated with DHAOx±R regimen(Dexamethasone 20 mg/day intravenous(Ⅳ)on day 1 to day 4,cytarabine 2 000 mg/m~2 3 h Ⅳ,every 12 hours on day 2;oxaliplatin 130 mg/m~2 2 h Ⅳ on day 1;with or without rituximab 375 ms/m~2 on day 0).Six patients were followed by high dose chemotherapy with autologous peripheral blood stem cell transplantation.Response to treatment wag assessed according to The International Working Group Criteria,including CR,PR,SD and PD.Side effects were graded according to WHO criteria,including 0-Ⅳ grades.[Results]Twenty patients received 47 cycles chemotherapy,13 patients(65%)received DHAOx chemotherapy and 7(35%)received DHAOx+R.The response rate(RR)for the whole group was 55%(11/20)with comeplete response(CR)rate 35%(7/20).The response can also be obtained in the patients who were already treated by platinum-based regimen before.The major toxicity Wag myelosuppression.The incidence of grade Ⅲ～Ⅳ neutropenia Wag 35%(16/47),and febrile neutropenia was 17%(8/47).The incidence of grade Ⅲ～Ⅳ thrombocytopenia was 20%(9/47).Eight cycles(17%)occurred mild neumtoxicity.With median follow-up of 12 months,1 and 2-year overall survival rate were 70.6%.[Conclusion]DHAOx was an effective regimen for recurrent and relapsed NHL patients with mild side effects and further investigation is needed.