DICE方案联合恩度治疗复发难治弥漫大B细胞淋巴瘤的临床研究  

The efficacy and safety of the DICE regimen in combination with rh-endostatin (Endostar) in the treatment of recurrent or refractory difuse large B-cell lymphoma: a prospective clinical trial

作　　者：林宁晶[1] 宋玉琴[1] 郑文[1] 涂梅峰[1] 傅志英 谢彦[1] 王小沛[1] 平凌燕 应志涛[1] 张晨[1] 邓丽娟[1] 刘卫平[1] 朱军[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所淋巴肿瘤科,恶性肿瘤发病机制及转化研究教育部重点实验室

出　　处：《肿瘤》2013年第9期802-808,共7页Tumor

摘　　要：目的:探讨DICE方案联合恩度治疗复发难治弥漫大B细胞淋巴瘤(difuse large B-cell lymphoma,DLBCL)的疗效和安全性。方法:全组15例患者均接受DICE方案联合恩度治疗。地塞米松10 mg/d静脉给药d 1~4;异环磷酰胺1 g·m^(-2)·d^(-1)静脉给药(给予美司钠解救)d 1~4;顺铂25 mg·m^(-2)·d^(-1)静脉给药d 1~4;依托泊苷60 mg·m^(-2)·d^(-1)静脉给药d 1~4。恩度7.5 mg·m^(–2)·d^(–1)静脉给药d 1~14。每21~28 d为1个化疗周期。2个周期后评价近期疗效和不良反应,分析生存情况。结果:2009年1月—2011年9月共入组15例患者中,其中难治患者11例(73.3%),复发患者4例(26.7%)。2例(13.3%)获完全缓解,2例(13.3%)获部分缓解,总有效率为26.7%。在各项临床因素中,性别(P=0.011)、国际预后指数(P=0.033)和血清乳酸脱氢酶水平(P=0.011)对总有效率有明显影响。全组患者的中位生存时间为10个月,1年总生存率为46.7%;中位治疗失败时间为2个月,1年治疗失败率为26.7%。主要不良反应为骨髓抑制,Ⅲ~Ⅳ度白细胞和中性粒细胞下降均为11例(78.6%)。结论:DICE方案联合恩度治疗复发难治DLBCL有一定疗效,未发现显著不良反应,不良反应也未明显增加。今后可扩大病例数开展进一步研究。Objective： To evaluate the efficacy and safety of the DICE regimen in combination with recombinant human endostatin （Endostar） in patients with recurrent or refractory DLBCL （diffuse large B-cell lymphoma）. Methods： DICE regimen were given intravenously for 4 consecutive days, consisting of dexamethasone 10 mg/d, ifosfamide 1 g·m^-2·d^-1, cisplatin 25 mg·m^-2·d^-1, and etoposide 60 mg·m^-2·d^-1. Endostar were given at 7.5 mg/m^2 （i.v.） on days 1-14. Cycles were repeated every 3 or 4 weeks. Results： Between January 2009 and September 2011, 15 patients with recurrent or refractory DLBCL were enrolled： 11（73.3%） with primary refractory lymphoma and 4 （26.7%） with recurrent lymphoma. Two patients （13.3%） achieved a complete remission and 2 （13.3%） achieved a partial remission. The overall response rate was 26.7%. The clinical factors of gender （P=0.011）, International Prognostic Index （P = 0.033） and serum lactate dehydrogenase level （P = 0.011） had significant effects on overall response rate. The TTF （median time to treatment failure） and the OS （overall survival） time were 2 and 10 months, respectively. The one-year OS rate and the TTF rate were 46.7% and 26.7%, respectively. Myelosuppression was the major toxicity. WHO grade Ⅲ/Ⅳ leukopenia and granulocytopenia were developed in 11 patients （78.6%）. Condusion： DICE regimen in combination with Endostar was well tolerated and its efficacy was mild in patients with recurrent or refractory DLBCL, probably due to these extremely poor prognostic patients.

关 键 词：非霍奇金淋巴瘤 弥漫大B细胞淋巴瘤 重组人血管内皮抑制素 DICE方案 复发 难治 

分 类 号：R733.7[医药卫生—肿瘤]