来那度胺治疗中高危B细胞非霍奇金淋巴瘤临床观察  

Clinical observation of lenalidomide in treatment of high-intermediate-risk B-cell non-Hodgkin lymphoma

作　　者：黄磊[1] 俞晴[1] 吴超[1] 徐文彬[1] 叶晨静[1] 阎骅[1] Huang Lei;Yu Qing;Wu Chao;Xu Wenbin;Ye Chenjing;Yan Hua(VIP Health Center,Ruijin Hospital Affiliaied to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院特需医疗中心,200025

出　　处：《白血病．淋巴瘤》2019年第2期91-95,共5页Journal of Leukemia & Lymphoma

摘　　要：目的 观察以来那度胺为基础的治疗方案治疗中高危B细胞非霍奇金淋巴瘤(B-NHL)的临床效果及安全性.方法 回顾性分析上海交通大学医学院附属瑞金医院2015年6月至2018年2月收治的23例中高危B-NHL患者,其中复发难治者7例,采用来那度胺联合利妥昔单抗(R2)+不同挽救化疗方案(DHAP、GDP、ICE)治疗,28 d为1个疗程;老年初治者5例,采用R2方案治疗,28 d为1个疗程;维持治疗者11例,采用来那度胺单药治疗,28 d为1个疗程,或采用R2方案治疗,3个月为1个疗程.临床观察主要终点为总有效,次要终点为无进展生存(PFS)时间及药物安全性.结果 复发难治组及老年初治组中位随访时间为4.5个月(1~20个月),其中复发难治组中位起效时间为3个月(2~7个月),3例获完全缓解(CR),总有效3例,中位PFS时间为7个月;老年初治组中位起效时间为4个月(2~5个月),4例可评价患者中1例获CR,2例获部分缓解(PR),总有效3例,中位PFS时间未达到.维持治疗组(11例)中位随访时间为15个月(2~32个月),中位PFS时间未达到,1年PFS率为64%(95%CI 36%~92%).最常见3~4级不良反应为白细胞减少和血小板减少,各占35%,大部分患者能耐受.结论 来那度胺作为免疫调节剂对老年初治、复发难治及维持治疗的中高危B-NHL患者疗效确切,并且安全可靠,可延长患者生存期.Objective To observe the clinical efficacy and safety of the lenalidomide-based therapy regimen in the treatment of high-intermediate-risk B-cell non-Hodgkin lymphoma (B-NHL). Methods A retrospective analysis of 23 high-intermediate-risk B-NHL patients who were admitted to Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2015 to February 2018 was conducted, of which 7 relapsed or refractory (R/R) patients received lenalidomide combined with rituximab (R2) and plus different salvage chemotherapy regimens (DHAP, GDP, ICE) of each 28-day cycle;5 elderly patients were initially treated with R2 of each 28-day cycle;11 patients were administered by maintenance monotherapy of lenalidomide of each 28-day cycle, or R2 therapy of 3-month cycle. The primary endpoint was overall response, and the secondary endpoints were progression-free survival (PFS) and safety. Results The median follow-up time was 4.5 months (1-20 months) in the R/R and elderly initial-treated patients. The median time to response in the R/R group was 3 months (2-7 months), of which 3 patients were complete remission (CR), overall response was 3 patients, and the median PFS was 7 months. The median time to response in the elderly initial treatment group was 4 months (2-5 months), 1 of 4 eligible patients was CR and 2 were partial remission (PR), overall response was 3 patients, and the median PFS time had not reached. The median follow-up time in the maintenance treatment group was 15 months (2-32 months), the median PFS time had not reached, and the 1-year PFS rate was 64% (95% CI 36%-92%). The most common grade 3-4 adverse events were leukopenia and thrombocytopenia, each accounting for 35%, and most patients were tolerable. Conclusion Lenalidomide as an immunomodulator is effective and safety for elderly initial treatment, R/R and maintenance treatment patients with high-intermediate-risk B-NHL, and it can prolong their survival.

关 键 词：淋巴瘤 非霍奇金 来那度胺 中高危 治疗 

分 类 号：R733.1[医药卫生—肿瘤]