吉西他滨联合奥沙利铂对多种化疗方案治疗失败后淋巴瘤患者的疗效及安全性评价  

Efficacy and safety evaluation of gemcitabine combined with oxaliplatin in lymphoma patients after failure of multiple chemotherapy regimens

作　　者：杨建良[1] 石远凯[1] 何小慧[1] 周生余[1] 董梅[1] 刘鹏[1] 张长弓[1] 秦燕[1] 杨晟[1] 桂琳[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所内科抗肿瘤分子靶向药物临床研究北京市重点实验室,100021

出　　处：《中华肿瘤杂志》2014年第2期137-140,共4页Chinese Journal of Oncology

基　　金：“十一·五”重大新药创制科技重大专项课题“抗肿瘤新药的临床评价研究技术平台建设”（2008ZX09312）;“十二·五”重大新药创制科技重大专项课题“抗肿瘤新药的临床评价研究技术平台建设”（2012ZX09303012）;卫生公益性行业科研专项靶向治疗和细胞治疗的规范化应用研究（200902002-1）;抗肿瘤分子靶向药物临床研究北京市重点实验室2012年度阶梯计划项目（Z121102009212055）;国家科技支撑计划项目恶性肿瘤转化医学和综合预防研究（2014BA109800）

摘　　要：目的 评价占西他滨联合奥沙利铂（GEMOX）方案在多种化疗方案治疗失败后淋巴瘤患者中的疗效和安全性.方法 回顾性分析经2种或2种以上的化疗方案治疗失败后、采用GEMOX方案进行解救化疗的27例淋巴瘤患者,探讨其与临床疗效相关的预测指标.结果 24例患者可评价近期疗效,其中完全缓解（CR）4例（16.7％）,部分缓解（PR）7例（29.1％）,稳定（SD）6例（25.0％）,进展（PD）7例（29.1％）,总缓解率为45.8％.在获得CR和PR的11例患者中,弥漫大B细胞淋巴瘤4例,霍奇金淋巴瘤4例,外周T细胞淋巴瘤1例,套细胞淋巴瘤1例,胃黏膜相关淋巴组织淋巴瘤1例.全组患者的中位无进展生存时间（PFS）为8个月（95％ CI为1.6～14.4个月）,11例获得CR和PR患者的中位PFS为19个月（95％ CI为11.1～26.8个月）.不良反应主要为骨髓抑制,其中出现Ⅲ～Ⅳ度中性粒细胞减少16例（59.3％）,出现Ⅲ～Ⅳ度血小板减少11例（40.7％）.前次化疗方案的敏感性与GEMOX方案的缓解率相关,前次化疗敏感患者的GEMOX方案缓解率为83.3％,前次化疗不敏感患者的缓解率为31.2％,差异有统计学意义（P=0.001）.结论 GEMOX方案对于经多种化疗方案治疗失败的淋巴瘤患者有较高的缓解率,患者耐受性好,部分患者能获得长期生存.对前次化疗敏感的淋巴瘤患者,GEMOX方案化疗的获益可能性更大.Objective To evaluate the efficacy and safety of gemcitabine combined with oxaliplatin （GEMOX） in lymphoma patients after failure of multiple chemotherapy regimens.Methods The clinical data of 27 lymphoma patients,who received GEMOX regimen after failure of two or more prior chemotherapy regimens,were retrospectively reviewed.The predictive factors related to the clinical efficacy of GEMOX regimen were explored.Results The efficacy could be evaluated in 24 patients.Complete response was obtained in 4 patients （16.7%）,partial response in 7 patients （29.1%）,stable disease in 6 patients （25.0%）,and progressive disease in 7 patients （29.1%）,with an overall response rate of 45.8%.Among the eleven CR and PR patients,four patients were with diffuse large B cell lymphoma,four patients with Hodgkin＆#39;s lymphoma,one with peripheral T cell lymphoma,one with mantle cell lymphoma and one with gastric mucosa-associated lymphoid tissue lymphoma.The median PFS time of the whole group was 8 months （95% CI,1.6-14.4 months）.For 11 CR and PR patients who had response to the GEMOX regimen,the median PFS time was 19 months （95% CI,11.1-26.8 months）.Major adverse response was hematologic toxicity.Among them,grade Ⅲ or Ⅳ neutropenia appeared in 16 patients （59.3%）,and grade Ⅲ or Ⅳ thrombocytopenia appeared in 11 patients （40.7%）.The sensitivity to the last chemotherapy was related to the efficacy of GEMOX regimen.The response rate was 83.3% in patients who had response to the last chemotherapy,and only 31.2% in the patients who failed to the last chemotherapy （P =0.001）.Conclusions GEMOX regimen can get a better response rate in lymphoma patients after failure of multiple chemotherapy regimens,and with a good tolerance and acceptable safety.Some patients can get long-term survival.Patients sensitive to the last chemotherapy are more likely to benefit from GEMOX regimen.

关 键 词：淋巴瘤 药物疗法 吉西他滨 奥沙利铂 治疗效果 

分 类 号：R733.1[医药卫生—肿瘤]