以左旋门冬酰胺酶为基础的方案治疗结外鼻型NK/T细胞淋巴瘤36例

 【摘要】 目的 观察以左旋门冬酰胺酶（L-ASP）为基础的方案治疗结外鼻型NK／T细胞淋巴瘤（ENKTL）的近期疗效、远期生存和不良反应。 方法 2008年2月至2011年9月，采用以L-ASP为基础的方案治疗ENKTL 36例。20例Ⅰ、Ⅱ期患者采用VLD方案联合放化疗，16例III、IV期患者行改良SMILE方案化疗，其中4例化疗后接受序贯受累野放疗。 结果 36例患者中35例可评价疗效，完全缓解（CR）率为54.3 %（19／35），总有效率为68.6 %（24／35）。中位随访13.5个月（3～31个月），全部患者1年总生存率为82 %，1年无疾病进展生存率为65 %。近期疗效评价有效的患者1年生存率（93 %）和无疾病进展生存率（80 %）均优于对治疗无应答的患者（35 %、33 %），差异有统计学意义（χ2＝13.909，P ＝ 0.000； χ2＝8.216，P＝ 0.004）。主要不良反应为骨髓抑制，无化疗相关性死亡。 结论 以L-ASP为基础的方案治疗ENKTL显示了较好的疗效，且耐受性好。L-ASP用于一线治疗ENKTL的大型前瞻性临床试验值得开展和深入研究。

Study of regimen based on L-asparaginase for 36 cases with nasal type extranodal NK/T cell lymphoma

Object To evaluate the efficacy and toxicity of L-asparaginase based regimen for extranodal nasal type NK/T cell lymphoma （ENKTL）. Methods 36 patients were treated with L-asparaginase based regimen from February 2008 to November 2011. 20 stage Ⅰ /Ⅱ patients were administered with VLD regimen based chemo-radiotherapy. 4 of 16 stage Ⅲ/Ⅳ patients received modified SMILE regimen chemotherapy, followed by involved field radiation therapy （IFRT）, while othe,＇s received modified SMILE regimen chemotherapy alone. Results Among 36 patients, 35 were eligible for treatment response evaluation.The overall response rate （RR） was 68.6% （24/35） with complete response （CR） rate of 54.3% （19/35）. Afterthe median follow-up of 13.5 （range 3-31） months, for all patients, the 1-year overall survival （OS） rate was 82 %, and the rate of progression-free survival （PFS） at 1 year was 65 %. The patients who attained responsewith treatment showed better 1-year OS （93 %） and PFS （80 %） as compared with patients without response （35 %; 33 %）, and the differences were statistically significant （X^2-13.909, P = 0.000; X^2=8.216, P = 0.004）. The major adverse event was myelosuppression. No chemotherapy-related mortality occurred. Conclusiion L-asparaginase based regimen is obviously effective and well tolerant for ENKTL. The large prospective clinical trials of L-asparaginase based regimen in the first-line treatment for ENKTL are worth for further investigation.