放疗同步应用奈达铂治疗中晚期食管癌的临床观察

目的：探讨放疗同步奈达铂单药化疗治疗中晚期食管癌的疗效和毒副反应。方法：２００７年４月～２００８年３月共３６例中晚期食管癌患者入组,采用６ＭＶ-Ｘ线常规放疗,每天１次,每次２Ｇｙ,每周照射５次,总量６０～６５Ｇｙ。于放疗之日起即给予奈达铂３０ｍｇ／次,每周１次,共６次,治疗结束后１个月评价近期疗效和毒副反应。结果：３６例患者中,ＣＲ６例（１６.７％）,ＰＲ２４例（６６.７％）,ＮＣ５例（１３.８％）,ＰＤ１例（２.８％）,有效率（ＣＲ＋ＰＲ）为８３.４％。毒副反应主要为骨髓抑制、消化道反应,但均可以耐受。结论：放疗同步奈达铂单药化疗治疗中晚期食管癌疗效较好,毒副反应可以耐受,值得进一步推广应用。     

MINE方案治疗复发难治性非霍奇金淋巴瘤23例

 目的 观察MINE（MIT、VP16、IFO）方案治疗复发及难治性非霍奇金淋巴瘤近期疗效及毒副反应。方法 23例经CHOP方案治疗失败的NHL患者接受MINE方案化疗至少2个周期，MIT6～8mg／m^2／d，静滴，d1；IFO 2．0静滴，d1-3，配合美司那400mg／次，0h、4h、8h静推3次；VP1680mg／m²／d，静滴，d1～3。疗效及毒性判定按照WHO标准。结果 完全缓解（CR）5例，部分缓解（PR）10例，稳定（SD）3例，进展（PD）5例，总有效率（CR＋PR）65．2％，毒副反应主要为骨髓抑制，白细胞减少率73．9％，以Ⅰ～Ⅱ度为主。经G-CSF支持后恢复正常，无与毒性相关的死亡发生。结论 MINE方案治疗难治性NHL有较高疗效，并较为安全，患者可耐受。     

BEPP方案治疗复发与难治性非霍奇金淋巴瘤近期疗效

目的 观察平阳霉素（PYM）、顺铂（DDP），足叶乙甙（VP-16）联合化学治疗复发与难治性非霍奇金淋巴瘤（non-Hodgkin‘slym-phoma,NHL)的近期疗效与毒性。方法 27例中，中度恶性11例，高度恶性16例，中位年龄47.34岁；难治性11例，复发性NHL16例，治疗方案：DDP40mg/m^2静滴d1-3,VP-16100mg/d静滴d1-5,PYM10mg/d肌注d1,3,5,Pred100mg/d口服d1-5，同时予以辅助止吐治疗及充分水化及利尿，21天为一个周期，连续应用2个周期以上评价疗效。结果 27例总缓解率66.7%，其中CR7例，PR11例；主要毒副反应为骨髓抑制与脱发，骨髓抑制多为Ⅰ-Ⅱ度，脱发100%。结论 BEPP方案治疗复发与难治性NHL疗效满意，不良反应轻，安全可靠。     

DHAP方案和GDP方案治疗复发或难治性非霍奇金淋巴瘤的比较研究

目的 观察和评价DHAP（顺铂、阿糖胞苷、地塞米松）和GDP（吉西他滨、顺铂、地塞米松）方案治疗复发、难治性非霍奇金淋巴瘤（Non—Hodgkin lymphoma，NHL）的疗效及毒副反应。方法45例复发、难治性NHL患者随机分成两组：DHAP方案组21例，采用顺铂、阿糖胞苷、地塞米松联合化疗；GDP方案组24例，采用吉西他滨、顺铂、地塞米松联合化疗，化疗2周期后评价疗效和毒副反应。结果全部患者均可评价疗效和毒副反应。DHAP组；完全缓解（CR）5例（23．8％），部分缓解（PR）9例（42．9％），稳定（SD）5例（23．8％），进展或恶化（PD）2例（9．5％），总缓解率（CR＋PR）66．7％；GDP组：CR4例（16．7％），PR10例（41．7％），SD7例（29．2％），PD3例（12．5％），总缓解率（CR＋PR）58．3％，总缓解率两组比较差异无统计学意义（P〉0．05）。主要毒副反应为消化道反应和骨髓抑制，患者均可耐受。消化道反应和白细胞减少两组比较差异无统计学意义（P〉0．05）；血小板减少DHAP组明显高于GDP组（P〈0．05）。结论DHAP和GDP方案治疗复发、难治性NHL的总缓解率相似，毒副反应均可耐受，DHAP方案血小板减少比GDP方案更明显。     

HEPP方案治疗难治性非霍奇金淋巴瘤的临床观察

 目的 观察由羟基喜树碱（HCPT）为主，联合依托泊苷（VP16）、顺铂（PDD）和泼尼松（PDN）组成的HEPP方案治疗难治性非霍奇金淋巴瘤（NHL）的客观疗效和毒副反应。方法 全组25例NHL患者，男性16例，女性9例，中位年龄55岁，均为复治病例。采用HEPP方案，即HCPT 8 mg／m2，静脉滴注，第1 ~ 5天；VP16 100 mg／d，静脉滴注，第1 ~ 5天，PDD 20 mg／d，静脉滴注，第1 ~ 5天，PDN 60 mg／m2，口服，第1 ~ 14天。28 d为1个周期，连续用药2个周期以上，按WHO标准评价近期疗效，并每周期观察毒副反应。结果 全组25例中，可以评价疗效的22例，获得完全缓解（CR）3例，部分缓解（PR）10例，稳定（SD）6例，进展（PD）3例，总有效率（CR+PR）60.0 %。中位肿瘤进展时间（TTP）为6个月。血液学毒性是该方案的主要毒副反应，白细胞下降的发生率为48.0 %，其中Ⅲ／Ⅳ度占24.0 %；血小板下降的发生率为20.0 %，Ⅲ／Ⅳ度占12.0 %。恶心、呕吐反应多为Ⅰ／Ⅱ度，口腔炎、肝功能异常、便秘给予相应处理后均能在短期恢复。结论 HEPP方案治疗难治性NHL的近期疗效满意，毒副作用可耐受，值得临床进一步观察使用。     

卡培他滨单药或联合用药治疗复发／转移性乳腺癌的疗效观察

目的评价卡培他滨（capecitabine）单药或联合用药作为姑息方案治疗复发／转移性乳腺癌的近期疗效和毒副反应。方法卡培他滨单药方案：20例患者每天予卡培他滨2510mg／m2,分早、晚2次口服,连续服用2周后休息1周为1个周期。联合用药方案：17例予卡培他滨联合吉西他滨（GX方案）;15例予卡培他滨联合长春瑞滨（NX方案）;20例予卡培他滨联合多西紫杉醇（TX方案）。每例患者至少进行2个周期的治疗。结果卡培他滨单药方案的有效率为25．0％,中位疾病进展期（TTP）为3．2个月。联合方案中GX方案的有效率为29．4％,TTP为3．7个月;NX方案的有效率为26．7％,TTP为3．5个月;TX方案的有效率为35．0％,TTP为3．8个月。主要毒副反应为白细胞减少、手足综合征、皮肤色素沉着、恶心、呕吐、厌食、疲劳等,少数患者出现口腔炎、头晕、腹泻和胸闷。Ⅲ～IV级毒副反应主要发生在TX方案,发生率为15％。结论作为姑息治疗方案,卡培他滨单药或联合用药治疗复发／转移性乳腺癌的有效率均≥25％,联合用药组的有效率比单药组提高,疾病控制的时间联合用药组较单药组延长。患者对卡培他滨单药及联合用药的毒副反应均可耐受。     

异环磷酰胺、顺铂为主联合治疗难治性非何杰金氏淋巴瘤12例

异环磷酰胺（IFO）是一种具有广谱抗肿瘤活性的恶唑磷酰胺，近年来用于治疗软组织肉瘤和其它实体瘤取得满意疗效。我院自1995年以来用IFO、顺铂（DDP）为主联合其它药物治疗难治性NHL12例，取得满意疗效。现报告如下。1．难治性NHL标准：所有患者均经病理学确诊NHL，收入院经正规CHOP、BACOP、或proMACE／cytaBOM方案化疗或上述方案交替应用2～8周期无效或治疗过程中、缓解后复发者。2．病人资料：难治性NHL患者12例，男9女3例，年龄21～58岁，平均38土12．5岁。按国际分类（1981年）划分低度恶性NHL1例、中度恶性6例、高度…     

拓扑替康单药治疗21例复发难治性非霍奇金淋巴瘤

[目的]观察拓扑替康单药治疗复发难治性非霍奇金淋巴瘤(NHL)的疗效及其毒副反应。[方法]复发难治性NHL患者21例,采用拓扑替康0.6mg/(m2·d),静脉滴注,d1￣5,21d为1个周期,共计2￣3个周期。[结果]拓扑替康单药的有效率为61.90%(13/21),其中完全缓解5例,毒副反应以血液毒性为主,Ⅲ Ⅳ度白细胞和血小板下降发生率分别为28.57%(6/21)和42.86%(9/21)。[结论]拓扑替康单药治疗复发难治性NHL具有较好的疗效,可以作为NHL的二线补救治疗药物应用。     

以博安霉素为主的新方案治疗难治性非霍奇金淋巴瘤的疗效观察

 目的　观察以博安霉素为主的新方案治疗化疗后肿瘤反弹较快而骨髓造血功能较差的复发难治性非霍奇金淋巴瘤（NHL）患者的疗效和不良反应。方法　采用新组合的B-VIP方案[博安霉素8.73 mg静脉滴注第1、4、8、12、15天,长春新碱（VCR）2 mg静脉滴注第1、8、15天,异环磷酰胺（IFO）每天1.2 g／m2静脉滴注第1天至第3天、第15天至第17天,泼尼松50 mg口服第1天至第10天,21 d为1个疗程]治疗常规方案治疗无效或难以耐受的复发难治性NHL 6例,该组患者此前已用其他方案化疗平均8.3个周期。结果　6例均可评价疗效和不良反应,总有效4例,完全缓解（CR）1例,部分缓解（PR）3例。主要不良反应为骨髓抑制,其他不良反应较少。结论　B-VIP方案是常规方案治疗无效或难以耐受标准化疗而肿瘤进展较快的复发难治性NHL的有效方案,毒性较低,较为经济。     

长程口服低剂量单剂VP—16治疗难治或复发后淋巴瘤

1994年4月～1996年2月以长程低剂量单剂VP－16口服法（VP－1650mg／m2／d×21天，P．0）治疗难治或复发后NHL48例，疗效满意，现报道如下：1临床资料难治指初治出现耐药，即曾用正规CHOP方案治疗2疗程，未能取得完全缓解（CR），再改用COMP方案治疗2疗程，仍不能取得CR者，或虽取得部分缓解（PR），但一停药肿块又迅速增大者。复发指经初治曾取得CR，后又行巩固化疗或对原发灶大的部位给以局部放疗，而又出现肿块，再经CHOP或COMP方案治疗无效者。本组48例NHL中，难治33例、复发15例。其中低度恶性11例、中高度恶性37例，均经…     

Effective treatment of indolent non-hodgkin's lymphomas with mitoxantrone, chlorambucil and prednisone

Since indolent non-Hodgkin's lymphomas (NHL) represent about 35% of all malignant lymphomas and mainly affect elderly patients, availability of a conventional chemotherapy regimen with high efficacy and low toxicity is of clinical importance. Patients and Methods: We retrospectively analysed 13 patients with advanced indolent NHL who were treated with 6-9 cycles of MCP: mitoxantrone 8 mg/m2 (days 1 and 2), chlorambucil 3 x 3 mg/m2 (days 1-5) and prednisone 25 mg (days 1-5) every 4 weeks. Results: The overall response was 84% (61% complete response, 23% partial response), 1 patient had stable disease and 1 patient experienced progressive disease. Median time to progression was 37 months (95% CI: 20-53) and the median survival has not yet been reached. The main toxicity (66%) was neutropenia (WHO grade III). There was no hair loss and no cardial or neurologic adverse event. Conclusion: In summary, MCP is an effective and well tolerated chemotherapy regimen and is probably an alternative to the more toxic CHOP regimen, especially in older patients.     

氟达拉滨联合吡柔比星治疗复发难治性惰性非霍奇金淋巴瘤

 目的　探讨FT（氟达拉滨及吡柔比星）方案治疗复发难治惰性非霍奇金淋巴瘤（NHL）的有效性和安全性。方法　复发难治惰性NHL40例,采用FT方案化疗,28 d为1个周期,共6个周期。FND（氟达拉滨、米托蒽醌及地塞米松）方案治疗惰性NHL的数据为对照。结果　FT组40例共治疗228个周期,有效率62.5 %,中位无进展生存期超过20个月,2年总生存率70.0 %,与对照组相似（P＞0.05）;不良反应以中性粒细胞减少（80.0 %）最为常见,但Ⅲ～Ⅳ度中性粒细胞减少症和肺炎的发生率均低于对照组,分别为12.5 %、29.0 %和2.5 %、23.0 %（P＜0.05）。结论　FT方案治疗复发难治惰性NHL安全有效,骨髓抑制轻,感染发生率低。     

A phase II study of topotecan in non-Hodgkin's lymphoma: an Ohio State University phase II research consortium study

Purpose: This multicenter phase II trial evaluated the efficacy and toxicity of the topoisomerase I inhibitor topotecan (TPT, 9-dimethylaminomethyl-10-hydroxycamptothecin) in patients with refractory or relapsing non-Hodgkin's lymphoma.

Patients and methods: Thirty-two patients with previously treated non-Hodgkin's lymphoma were accrued in this study from June 1992 to June 1997. Patients were eligible if they had measurable disease and had received two or less chemotherapy treatments for indolent lymphoma or no more than one treatment for aggressive lymphoma. Nineteen patients with aggressive lymphoma including seven with transformed indolent disease and 11 patients with indolent disease were treated. Two additional patients had both indolent and aggressive lymphoma in the bone marrow and lymph nodes at entrance into the study. Topotecan was administered as a 30-min infusion at a dose of 1.25 mg/m² for five days and repeated at three week intervals.

Results: Thirty-two patients were evaluable for toxicity and 29 patients were evaluable for response. There were five objective responses including two complete remissions and three partial remissions (17%; CI 4-30%). Four of the five responders had aggressive disease and had been responsive to prior chemotherapy. The duration of remissions were short, lasting a median of 2 months (range 2-52 months). The major toxicity seen was myelosuppression with 28 of the 32 patients having grade three or greater granulocytopenia.

Conclusion: Topotecan given as a five day 30 min infusion at a dose of 1.25 mg/m² has modest activity in previously treated non-Hodgkin's lymphoma as compared to other active agents.     

Pivotal study of iodine I 131 tositumomab for chemotherapy-refractory low-grade or transformed low-grade B-cell non-Hodgkin's lymphomas.

PURPOSE: To evaluate the efficacy and safety of tositumomab and iodine I 131 tositumomab (Bexxar; Corixa Corp, Seattle, WA, and GlaxoSmithKline, Philadelphia, PA) in patients with chemotherapy-refractory low-grade or transformed low-grade non-Hodgkin's lymphoma (NHL) and to compare its efficacy to the patients' last qualifying chemotherapy (LQC) regimens. PATIENTS AND METHODS: Sixty patients who had been treated with at least two protocol-specified qualifying chemotherapy regimens and had not responded or progressed within 6 months after their LQC were treated with a single course of iodine I 131 tositumomab. RESULTS: Patients had received a median of four prior chemotherapy regimens. A partial or complete response (CR) was observed in 39 patients (65%) after iodine I 131 tositumomab, compared with 17 patients (28%) after their LQC (P <.001). The median duration of response (MDR) was 6.5 months after iodine I 131 tositumomab, compared with 3.4 months after the LQC (P <.001). Two patients (3%) had a CR after their LQC, compared with 12 (20%) after iodine I 131 tositumomab (P <.001). The MDR for CR was 6.1 months after the LQC and had not been reached with follow-up of more than 47 months after iodine I 131 tositumomab. An independent review panel verified that 32 (74%) of the 43 patients with nonequivalent durations of response (> 30 days difference) had a longer duration of response after iodine I 131 tositumomab (P <.001). Only one patient was hospitalized for neutropenic fever. Five patients (8%) developed human antimurine antibodies, and one (2%) developed an elevated TSH level after treatment. Myelodysplasia was diagnosed in four patients in follow-up. CONCLUSION: A single course of iodine I 131 tositumomab was significantly more efficacious than the LQC received by extensively pretreated patients with chemotherapy-refractory, low-grade, or transformed low-grade NHL and had an acceptable safety profile.     

利妥昔单抗联合CHOP方案治疗骨原发性非何杰金淋巴瘤的疗效和预后分析

目的骨的原发性淋巴瘤虽然可以通过化疗和放疗得到有效控制,但复发的比率很高。本研究旨在分析和评价利妥昔单抗联合CHOP方案治疗CD20阳性骨原发性非何杰金淋巴瘤的临床疗效及其安全性。方法回顾11例利妥昔单抗联合CHOP方案治疗的骨原发性非何杰金淋巴瘤患者临床资料,利妥昔单抗用药方法为375mg／m^2,于每周期化疗前1d静脉滴注,每3周为1个循环周期;6～8个周期后评价疗效及不良反应,同时与单纯应用CHOP化疗的患者进行回顾性疗效分析比较。结果11例患者接受利妥昔单抗联合CHOP方案化疗,完全缓解（CR）8例,部分缓解（PR）3例。随诊时间9—65个月,8例无瘤生存,1例转化为淋巴细胞型白血病,患者带瘤生存,2例死亡,患者生存率81．8％（9／11）,无病生存率72．7％（8／11）;Kaplan—Meier生存曲线计算应用利妥昔单抗的患者5年预期整体生存率（overall survival,OS）为60．6％。R—CHOP化疗后最常见的复发部位为中枢神经系统。不良反应与单纯应用CHOP化疗组无显著差异,主要为过敏和发热,以及化疗相关的血液学毒性,未出现爆发性肝衰竭。结论利妥昔单抗联合CHOP方案治疗骨原发性非何杰金淋巴瘤（CD20^＋）效果显著,如何降低中枢神经系统复发是今后的研究方向。     

Oral cyclophosphamide therapy for patients with residual or relapsed indolent-type lymphoma after initial treatment for aggressive lymphomas. A sub-group of patients with apparent transformed indolent lymphoma

Lymph node or bone marrow biopsy from sixty-one patients affected by aggressive non-Hodgkin lymphomas (NHL) were retrospectively evaluated to assess the histology at relapse. Eighteen cases (29.5%) were proven to have relapsed or persistent low-grade lymphoma after conventional therapy. In 5/18 patients association of low and high-grade lymphoma was detectable at diagnosis by bone marrow biopsy. In the remaining 13/18 no evidence of follicular lymphoma was detected at diagnosis. The outcome of these patients was compared to that of 43 patients relapsed without change in histology and treated by a second line therapy. Of these 43 patients, 13 were not responders (NR), 10 achieved a partial remission (PR) and 18 complete remission (CR). Two were lost during follow-up. The 18 patients with residual/relapsed indolent subtype received oral cyclophosphamide (100 mg/day for 15 days every month for six months): 3 of them had NR, 5 CR, and 10 PR. The overall survival (OS) median time was 39 months in low-grade resistant/relapsed patients and 20 months in patients with aggressive histology. OS at 24 months was 71 and 41%, respectively, (p < 0.02). Most of the patients with high-grade disease were refractory or relapsed after a median of five months, whereas cases with low-grade NHL showed a long lasting stable PR. We suggest that the higher grade patients with residual or relapsed low grade lymphoma were, in fact, transformed low-grade at diagnosis and, after removing the more aggressive component by chemotherapy, it is possible to manage these patients by conventional therapy for indolent lymphomas.     

Dexamethasone, cytarabine, ifosfamide, and cisplatin as salvage therapy in non-Hodgkin lymphoma

The authors conducted a phase II study to evaluate a new combination of chemotherapeutic drugs that includes dexamethasone, cytarabine, ifosfamide, and cisplatin as salvage therapy in non-Hodgkin lymphoma after prior exposure to both adriamycin and etoposide. All drugs were administered intravenously over 4 consecutive days. The daily dose of dexamethasone was 20 mg twice daily. The maximal daily doses of cytarabine, ifosfamide, and cisplatin were 75 mg/m2, 1,200 mg/m2, and 20 mg/m2, respectively. Cycles were repeated every 3 weeks. A total of 31 patients were entered in the trial. Thirty patients were evaluable for response. A complete response was seen in 11 patients (37%), and a partial response was noted in six patients (20%). A significantly higher complete response rate was seen in patients with relapsing non-Hodgkin lymphoma compared with those who failed to achieve a complete response with the last chemotherapy (10/14 vs. 1/16; p < 0.013). A complete response continues in two patients who received consolidation with high-dose chemotherapy for more than 49 months and more than 60 months for each patient. Median time to treatment failure and median survival were 3.3 months and 7.5 months, respectively, for the entire group and 11 months and 30 months, respectively, for complete responders. Myelosuppression was pronounced but was usually of short duration. Neutropenic fever developed in 13 patients (42%) and in 15 of 96 cycles (16%). Platelet transfusions were required in seven patients (23%). There was one drug-related death associated with myelotoxicity. Nonhematologic toxicity was not dose limiting. The authors conclude that dexamethasone, cytarabine, ifosfamide, and cisplatin is active and a relatively tolerable regime for patients with non-Hodgkin lymphoma previously treated with adriamycin and etoposide.     

利妥昔单抗联合CHOP方案治疗B细胞非霍奇金淋巴瘤的临床分析

目的 观察利妥昔单抗联合CHOP方案治疗CD20阳性B细胞非霍奇金淋巴瘤的临床疗效及毒副反应.方法 8例B细胞非霍奇金淋巴瘤均采用利妥昔单抗联合化疗,利妥昔单抗375 ms/m2于每1周期化疗前1天静脉滴注,每3周为1疗程,4～6周期后评价疗效及毒副反应.结果 8例患者中,CR 7例,PR 1例,总有效率100%.主要...     

FMD方案治疗惰性淋巴瘤的临床观察

 目的　分析FMD方案初治惰性淋巴瘤的疗效及毒副作用。方法　24例确诊惰性淋巴瘤患者初治采用FMD方案：氟达拉滨（Flu）25～30 mg·m-2·d-1,静脉滴注30 min,第1天至第3天;米托蒽醌（Mit）10 mg·m-2·d-1,静脉滴注30 min,第1天;地塞米松（Dxm）40 mg／d,静脉滴注,第1天至第5天。结果　24例患者中,完全缓解（CR）54.1 ％,部分缓解（PR）29.1 ％,有效率为83.2 ％。主要毒副作用是骨髓抑制。结论　FMD方案初治惰性淋巴瘤临床效果好,患者可以耐受,是一种安全有效的较理想的方案     

氟达拉滨联合方案治疗复发难治非霍奇金淋巴瘤临床疗效观察

目的观察氟达拉滨联合化疗治疗复发难治非霍奇金淋巴瘤临床疗效及安全性。方法38例复发难治非霍奇金淋巴瘤患者均采用FND方案：氟达拉滨30mg/m² d1~3,米托蒽醌10mg/m² d1,曲安西龙80mg pod 1~5, 28天一周期。结果全组患者CR 8例（21%）,PR 13例（34%）,有效率56%;其中20例复发难治惰性淋巴瘤患者CR7例（35%）,PR9例（45%）,有效率80%; 18例复发难治侵袭性淋巴瘤患者CR 1例（6%）,PR 4例（22%）,有效率28%（ χ²=10.45, P =0.001）。全组患者中位随访22（1~47）月,复发难治惰性淋巴瘤患者中位生存期45（2~47）月,中位无进展生存期18（2~34）月;复发难治侵袭性淋巴瘤患者中位生存期15（2~45）月,中位无进展生存期3（1~22）月。不良反应主要为骨髓抑制和肺感染。结论氟达拉滨联合方案治疗惰性淋巴瘤疗效肯定,对复发难治侵袭性淋巴瘤患者疗效尚可,不失为一种治疗选择。