Hyper-CVAD方案治疗侵袭性T细胞淋巴瘤的效果和安全性  

Efficacy and safety of Hyper-CVAD regimen for treatment of aggressive T-cell lymphoma

作　　者：蔡华聪[1] 崔静[1] 周道斌[1] 段明辉[1] 朱铁楠[1] 李剑[1] 庄俊玲[1] 韩冰[1] 张薇[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院血液内科,100730

出　　处：《白血病．淋巴瘤》2018年第1期28-32,36,共6页Journal of Leukemia & Lymphoma

摘　　要：目的 评价Hyper-CVAD化疗方案治疗侵袭性T细胞淋巴瘤的效果和安全性.方法 对2009年9月至2010年12月在北京协和医院接受Hyper-CVAD方案诱导化疗的34例初诊侵袭性T细胞淋巴瘤患者的疗效和不良反应等资料进行回顾性分析,并进行生存分析.结果 34例患者接受Hyper-CVAD方案诱导化疗后,28例（82.4％）有治疗反应,其中10例（29.4％）获得完全缓解（CR）;11例接受造血干细胞移植（包括1例同胞全合异基因造血干细胞移植）.中位随访时间16个月（1～82个月）,1、3年总生存（OS）率分别为70.2％、41.1％;1、3年无进展生存（PFS）率分别为49.3％、31.6％.化疗不良反应主要为骨髓抑制,18例（52.9％）发生Ⅳ级骨髓抑制;3例因严重感染死亡.Cox多因素分析显示,化疗能否达到CR是PFS的独立影响因素（HR=6.118,95％CI 1.327～28.206,P=0.020）;骨髓是否受累（HR=0.270,95％CI 0.101～0.722,P=0.009）和化疗能否达到CR（HR=6.669,95％CI 1.754～25.354,P=0.005）是OS的独立影响因素.结论 Hyper-CVAD方案诱导化疗治疗侵袭性T细胞淋巴瘤的反应率高,但有效持续时间短,远期疗效不佳,同时骨髓抑制严重,感染发生率高.缓解后行自体造血干细胞移植可能提高侵袭性T细胞淋巴瘤的疗效.Objective To evaluate the safety and efficacy of Hyper-CVAD intensive chemotherapy regimen in patients with newly diagnosed aggressive T-cell lymphoma. Methods The efficacy, side effects and survival status were retrospectively analyzed in 34 patients with newly diagnosed aggressive T-cell lymphoma who received Hyper-CVAD regimen as induction therapy in Peking Union Medical College Hospital from September 2009 to December 2010. Results Of 34 patients, 28 cases （82.4 %） showed treatment response, including 10 cases （29.4 %） of complete response （CR）. Eleven patients underwent stem cell transplantation, including 1 case of human leukocyte antigen-identical siblings allogeneic stem cell transplantation. The median follow-up was 16 months （1-82 months）, and the overall survival （OS） rate of 1 or 3-year was 70.2 % and 41.1 % respectively, and progression-free survival （PFS） rate of 1 or 3-year was 49.3 % and 31.6 % respectively. The major adverse reaction was myelosuppresion, including 18 cases （52.9%） of myelosuppresion with grade Ⅳ. Three patients died of serious infection. Cox regression multifactor analysis showed CR was the only influencing factor for PFS （HR=6.118, 95%CI 1.327-28.206, P=0.020）. Marrow involvement （HR= 0.270, 95 %CI 0.101-0.722, P= 0.009） and CR （HR= 6.669, 95 %CI 1.754-25.354, P= 0.005） were independent influencing factors for OS. Conclusions Hyper-CVAD regimen has a high response rate for aggressive T-cell lymphoma, but the lasting effectiveness and the short-term efficacy show unfavorable performances. Meanwhile, myelosuppression is serious and infection incidence is high. Autologous hematopoietic stem-cell transplantation after remission may improve the outcome.

关 键 词：淋巴瘤 T细胞 侵袭性 抗肿瘤联合化疗方案 疗效 安全性 

分 类 号：R733.1[医药卫生—肿瘤]