DHAOx方案治疗复发和难治性非霍奇金淋巴瘤的研究  

Clinical Outcomes of Patients with Relapse and Refractory Non-Hodgkin’s Lymphoma Treated by DHAOx Regimen

作　　者：蔡清清[1,2] 高岩[1,2] 周颖[1,2] 卜庆[1,2] 林旭滨[1,2] 王潇潇[1,2] 林泽晓[1,2] 黄慧强[1,2] 

机构地区：[1]中山大学肿瘤防治中心内科 [2]国家华南肿瘤学重点实验室,广东广州510060

出　　处：《中山大学学报（医学科学版）》2010年第2期269-273,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(8151008901000043);广东省科技计划项目(0711220600052)

摘　　要：【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20mg/d静脉滴注d1～4;阿糖胞苷2000mg/m23h静脉滴注,12h重复一次d2;奥沙利铂130mg/m22h静脉滴注d1;加或不加抗CD20单克隆抗体利妥昔单抗375mg/m2,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年美国和国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),其中粒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。【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 mg/m^2 on day 0）. Six patients were followed by high dose chemotherapy with autologous peripheral blood stem cell transplantation. Response to treatment was 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 was myelosuppression. The incidence of grade Ⅲ～Ⅳ neutropenia was 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 neurotoxicity. 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.

关 键 词：非霍奇金淋巴瘤 化学疗法 DHAOx方案 

分 类 号：R733.1[医药卫生—肿瘤]