培门冬酰胺酶联合GEMOX方案治疗结外NK／T细胞淋巴瘤的疗效和出凝血功能的改变  

Efficacy of pegaspargase combined with GEMOX regimen on extranodal natural killer/T-cell lymphoma and its influence on coagulation function

作　　者：邹丽芳[1] 姚一芸[1] 庄衍[1] 窦红菊[1] 朱琦[1] 胡钧培[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院血液科,200021

出　　处：《白血病．淋巴瘤》2016年第4期216-219,223,共5页Journal of Leukemia & Lymphoma

摘　　要：目的观察培门冬酰胺酶（PEG-ASP）联合GEMOX方案治疗结外NK／T细胞淋巴瘤患者的疗效及化疗前后出凝血功能的改变。方法收集2010年1月至2014年12月结外NK／T细胞淋巴瘤患者35例，采用PEG-ASP联合GEMOX方案化疗共180个疗程，观察其有效率。检测每位患者化疗前1天和化疗后第8天和第14天，凝血酶原时间（PT）、活化部分凝血酶原时间（AFIT）、纤维蛋白原（Fbg）、国际标准化比值（INR）等常规出凝血指标，并与健康对照组相比。结果在35例结外NK／T细胞淋巴瘤患者中，Ⅰ～Ⅱ期11例，占31．43％。Ⅲ-Ⅳ期24例，占68．57％。采用PEG-ASP联合GEMOX方案化疗共180个疗程，预计平均每例做6个疗程，总有效率71．43％，其中Ⅰ～Ⅱ期有效率81．82％（9例），Ⅱ-Ⅳ期有效率66．67％（16例）。35例患者与化疗前1天和健康对照组相比，化疗第8天PT和APTT延长、Fbg下降，第14天仍存在着APTT延长、Fbg下降，差异均有统计学意义（均P〈0．05）。化疗前1天与健康对照组相比，APTT、Fbg差异无统计学意义（P〉0．05）。其他指标差异也无统计学意义（P〉0．05）。结论PEG．ASP联合GEMOX方案治疗结外NK／T细胞淋巴瘤比传统方案更安全有效，但同时存在着可控的不良反应，其中值得注意的是出凝血机制的异常，适当的止血措施、及时补充血浆、凝血酶原复合物（PPSB）和Fbg是必要的治疗。Objective To evaluate the efficacy of pegaspargase （PEG-ASP） combined with GEMOX regimen for the treatment of extranodal natural killer （NK） / T-cell lymphoma （ENKL）, and to observe the changes of coagulation function. Methods 35 patients with histologically confirmed ENKL were enrolled from January 2010 to December 2014. All patients received 180 cycles of PEG-ASP combined with GEMOX chemotherapy and the efficacies were observed. The coagulation items such as prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fbg） and international normalized ratio （INR） were tested respectively on day 1st, day 8th and day 14th of every treatment cycle. Results Among 35 patients, 11 patients （31.43 %） were in stage Ⅰ -Ⅱ, and 24 patients （68.57 %） were in stage Ⅲ-Ⅳ. All patients were subjected to 180 cycles of PEG-ASP combined with GEMOX chemotherapy, and each case was estimated to receive 6 cycles. The overall response （CR＋PR） rate （ORR） was 71.43 % （25/35）, the ORR was 81.82 % （9/11） in stage Ⅰ -Ⅱ group, and 66.67 % （16/24） in stage Ⅲ-Ⅳ group. The increased PT and APTT and decreased Fbg were observed on day 8th of the chemotherapy. The increased APTT and decreased Fbg were still observed on day 14th of the chemotherapy. Compared the data of patients one day before chemotherapy with healthy persons, the changes had statistical significance （P 〈 0.05）. Conclusions PEG-ASP combined with GEMOX regimen in the treatment of ENKL is safer and more effective compared with traditional chemotherapy, but the abnormal alternations of coagulation might be common during therapy. Dealing with the bleeding risk and supplement with plasma, PPSB or Fbg in time should be necessary.

关 键 词：结外NK/T细胞淋巴瘤 培门冬酰胺酶 治疗结果 出凝血功能 

分 类 号：R733.1[医药卫生—肿瘤]