148例侵犯骨髓的非霍奇金淋巴瘤不同方案疗效分析  

Cfinical outcomes of different regimens for non-Hodgkin＇s lymphoma with bone marrow involvement： analysis of 148 cases

作　　者：李桥川 袁晓莉 王亚非 邹德慧 赵耀中 邱录贵 

机构地区：[1]中国医学科学院协和医学院血液学研究所血液病医院实验血液学国家重点实验室,天津300020

出　　处：《中华医学杂志》2008年第4期254-257,共4页National Medical Journal of China

基　　金：天津市高科技发展计划基金资助项目（06YFSYSF1900）;天津市自然科学基金资助项目（06YFJMSC08500）

摘　　要：目的探讨不同化疗方案对侵犯骨髓的非霍奇金淋巴瘤（NHL）患者的治疗效果。方法对148例确诊有骨髓侵犯的NHL患者的治疗情况进行回顾性分析。结果（1）148例患者治疗总有效率为80．4％，其中完全缓解（CR）率为60．7％。增强化疗剂量组和CHOP方案组的总有效率分别为84．3％和64．1％。（2）89例B细胞NHL患者中，造血干细胞移植（HSCT）组和利妥昔单抗联合化疗组的3年及5年总体生存（OS）率和无进展生存（PFS）率显著高于CHOP方案组和增强化疗剂量组（P〈0．05）；增强化疗剂量组的3年及5年OS率及PFS率显著高于CHOP方案组（P〈0．05）；（3）59例T细胞NHL患者中，增强化疗剂量组和HSCT组的3年及5年OS率和PFS率显著高于CHOP方案组（P〈0．05）。结论NHL侵犯骨髓预后差，增加化疗强度或造血干细胞移植治疗可能会提高其治疗有效率及长期生存率；其中利妥昔单抗联合化疗能够显著提高CD20^＋B细胞NHL的疗效。Objective To investigate the effects of different treatment protocols on non-Hodgkin＇s lymphoma （NHL） with bone marrow involvement （BMI）. Methods The clinical data of 148 patients of NHL with BMI, 108 undergoing CHOP regimen, 51 undergoing dose-intensive CHOP regimens, 13 undergoing CHOP regimen ＋ rituximab, and 27 undergoing hemopoietic stem cell transplantation （HSCT） after CHOP protocol with remission. The curative effects were retrospectively analyzed. Results （ 1 ） The response rate （RR） for the whole group was 80.4% , with a complete remission （CR） rate of 60.7%. The response rate of the patients treated with the dose-intensive regimens （dose-intensive group） was 84.3% , significantly higher than that of the patients treated with standard CHOP regimen （ 64.1% , P 〈 0. 05 ）. （ 2 ） The 3- and 5-year overall survival （OS） rates and progress-free survival （PFS） of the B-cell NHL patients who underwent HSCT ＋ Rituximab treatment （ Rituximab combined with chemotherapy ） were significantly higher than those of the dose-intensive group and CHOP group, and the 3- and 5-year OS rates and PFS of the dose-intensive group were all significantly higher than those of the CHOP group （ all P 〈 0. 05 ）. （ 3 ） The 3- and 5-year OS rates, and PFS of the T-cell NHL patients who underwent HSCT group and dose- intensive CHOP were all significantly higher than those patients who underwent CHOP regimen （ all P 〈 0.05 ）. Conclusion Superior survival may benefit from Dose-intensive regimens and HSCT, may be good choices for the patients with NHLBMI, a group of heterogeneous malignancies with poor prognosis. And combined chemotherapy with Rituximab treatment remarkably raises the effect for CD20^＋ B-cell NHLBMI.

关 键 词：非霍奇金淋巴瘤 骨髓侵犯 造血干细胞移植 治疗效果 

分 类 号：R686[医药卫生—骨科学]