CCMA联合化疗辅加中药治疗47例晚期NSCLC的疗效观

采用ＣＣＭＡ联合化疗方案辅加中药治疗４７例晚期非小细胞肺癌,其中鳞癌２６例,腺癌２１例;Ⅲ期１２例,Ⅳ期３５例;癌细胞分化较差２２例,分化较好２５例。全组ＣＲ、ＰＲ率分别为１７．０％和３４．０％,ＣＲ＋ＰＲ率为５１．１％。鳞癌ＣＲ＋ＰＲ为３８．５％,腺癌为６６．７％（ｐｔ＝２．０２）,前者的中位生存期为１５．４个月,后者为２１．５个月（Ｐ＜０．０５）。癌细胞分化较差者的ＣＲ＋ＰＲ率为７２．７％,分化较好的为２４．０％（ｐｔ＝３．８１）,前者的中位生存期为２７．４个月,后者为１４．３个月（Ｐ＜０．０５）。全组２４例有效者的中位生存期为３２．４个月,２３例无效者为８．５个月（Ｐ＜０．０１）,治疗后１,２,３,４ａ生存率分别为６３．８％,２３．４％,１９．１％和１５．０％     

40例非何杰金淋巴瘤白血病治疗研究

本文报告４０例经病理证实的非何杰金淋巴瘤白血病，以ＣＨＯＰ为主或ＢＣＨＯＰ与ＢＥＰＰＡ交替方案进行治疗，近期疗效ＣＲ率７．５％（３／４０），ＰＲ率３０％（１２／４０），总有效率３７．５％，总中位生存期７．５个月，高度恶性组中位生存期５个月，低度恶性组１９个月。     

COMP和PBM化疗方案治疗晚期鼻咽癌的疗效分析

我们以ＣＴＸ＋ＶＣＲ＋ＭＴＸ＋ＤＤＰ（ＣＯＭＰ）和ＤＤＰ＋ＢＬＭ＋ＭＴＸ（ＰＢＭ）两种化疗方案治疗复发和转移的晚期鼻咽癌５８例。４９例可评价客观疗效。结果ＣＯＭＰ组取得ＣＲ３例、ＰＲ９例，有效率（ＣＲ＋ＰＲ）为５２．２％；ＰＢＭ组ＣＲ１例、ＰＲ９例，有效率（ＣＲ＋ＰＲ）为３８．５％。两者无显著性差异（Ｐ＞０．０５）．治疗后有效病例缓解期为５～５６月，中位缓解期为２５月。两种方案对鼻咽癌肺转移均较好，对肝转移疗效最差。ＣＯＭＰ方案对鼻咽癌远处转移疗效较好，对肺转移有效率为５８．３％（７／１２）．可作为鼻咽癌远处转移尤其是肺转移的首选。ＰＢＭ方案对鼻咽癌原灶复发疗效较好，对鼻咽癌复发有效率为４２．９％（３／７），可作为鼻咽癌原灶复发或放射治疗后辅助化疗首选方案。     

COMP与PBM化疗方案治疗晚期鼻咽癌的疗效分析

我们以ＣＴＸ＋ＶＣＲ＋ＭＴＸ＋ＤＤＰ（ＣＯＭＰ）和ＤＤＰ＋ＢＬＭ＋ＭＴＸ（ＰＢＭ）两种化疗方案治疗复发和转移的晚期鼻咽癌５８例，４９例可评价客观疗效。结果ＣＯＭＰ组取得了ＣＲ３例，ＰＲ９例，有效率（ＣＲ＋ＰＲ）为５２．２％；ＰＢＭ组ＣＲ１例，ＰＲ９例，有效率（ＣＲ＋ＰＲ）为３８．５％。两者无显著性差异（Ｐ〉０．０５）。治疗后有效病例缓解期为５～５６月，中位缓解期为２５月。两种方案对鼻咽癌肺转移均较     

Ⅱ期咽淋巴环非霍奇金淋巴瘤治疗探讨

目的探讨Ⅱ期咽淋巴环非霍奇金淋巴瘤的治疗。材料与方法１９８７年１月至１９９２年９月共收治Ⅱ期咽淋巴环淋巴瘤１３２例。疗前常规作上消化道钡餐检查（ＧＩ），原则上作化、放综合治疗。１９８９年２月前后分别用ＣＯＭＰ（环磷酰胺、长春新碱、氨甲蝶呤、强的松）和ＣＨＯＰ（环磷酰胺、长春新碱、阿霉素、强的松）方案化疗。放疗前后各化疗２～３周期，放疗常规用面颈联合野，照射剂量４０～６０Ｇｙ／４～７周。结果ＧＩ查出６例胃受累，但均为纤维胃镜否定。ＣＨＯＰ组完全缓解（ＣＲ）率为６１．２％，部分缓解（ＰＲ）率３８．８％。ＣＲ者５年生存率为９０．０％，ＰＲ者为５７．９％（Ｐ＜０．０１）。ＣＨＯＰ组５年生存率为７６．３％，ＣＯＭＰ组为４６．３％（Ｐ＜０．００５）。放疗剂量＜５０Ｇｙ与≥５０Ｇｙ生存率无明显差异。有６例特别病例先用ＣＨＯＰ化疗达ＣＲ，１例未放疗，另５例仅分别照射２０，３４，３６，３８，和３８Ｇｙ。这６例均无瘤生存５年以上。结论疗前分期检查中似可不必再作ＧＩ。ＣＨＯＰ方案化疗明显提高生存率，建议Ⅱ期患者应首选化疗。化疗达ＣＲ者酌降照射剂量。     

CCMA联合化疗辅加中药治疗47例晚期NSCLC的疗效观察

采用ＣＣＭＡ联合化疗方案辅加中药治疗４７例晚期非小细胞肺癌,其中鳞癌２６例,腺癌２１例;Ⅲ期１２例,Ⅳ期３５例;癌细胞分化较差２２例,分化较好２５例,全组ＣＲ、ＰＲ率分别为１７．０％和３４．０％,ＣＲ＋ＰＲ率为５１．１％。鳞癌ＣＲ＋ＰＲ为３８．５％,腺癌为６６．７％,前者的中位生存期为１５．４个月,后者为２１．５个月,癌细胞分化较差者的ＣＲ＋ＰＲ率为７２．７％,分化较好的为２４．０％,前者的中位生     

ELFP方案治疗晚期胃癌近期疗效分析

本文报告应用ＥＬＦＰ方案治疗晚期胃癌３０例，ＣＲ６例（２０％），ＰＲ１５例（５０％），ＮＣ４例（１３．３％），ＰＤ５例（１６．７％），总有效率（ＣＲ＋ＰＲ）７０％。主要毒副反应为轻中度消化道反应和骨髓抑制，用ＰＤＤ腹腔化疗后有１０例（３３．３％）发生一过性腹痛。     

ELFP方案治疗晚期胃癌近期疗效分析

本文报告应用ＥＬＦＰ方案治疗晚期胃癌３０例，ＣＲ６例（２０％），ＰＲ１５例（５０％），ＮＣ４例（１３．３％），ＰＤ５例（１６．７％），总有效率（ＣＲ＋ＰＲ）７０％。主要毒副反应为轻中度消化道反应和骨髓抑制，用ＰＤＤ腹腔化疗后有１０例（３３．３％）发生一过性腹痛。     

71例复发性儿童非何杰金氏淋巴瘤临床分析

我院于１９７９～１９９１年收治初治获得完全缓解而复发的儿童非何杰金氏淋巴瘤７１例，均经病理证实。分期：Ｉ期２例，Ⅱ期，４０例，Ⅲ期１４例，Ⅳ期１５例，７１例中６８例给予ＣＯＣＰ／ＣＨＯＰ交替化疗４～８周期，３例沿用初治方案ＣＯＣＰ化疗４周期，结果：ＣＲ３４例，占４７．９％，ＰＲ２２列，占３１．０％，有效率为７８．９％，１，３，５年生存率分别为５３．５％，２６．８％，２１．１％，再化疗疗效较好。本文     

ILFC方案治疗进展期胃癌的临床观察

「目的」观察表阿霉素（ＥＰＩ）、甲酰四氢叶酸（ＣＦ）、５氟尿嘧啶（５－Ｆｕ）和卡铂（ＣＢＰ）联合化疗治疗进展期胃癌的疗效和耐受性。「方法」应用ＥＰＩ、ＣＦ、５－Ｆｕ和ＣＢＰ（ＥＬＦＣ）联合化疗治疗进展期胃癌３２例，至少３疗程。「结果」ＣＲ１８．７％（５／３２），ＰＲ４３．８％（１４／３２），ＣＲ＋ＰＲ６２．５％。毒副反应有厌食、恶心、呕吐等消化道反应和在抑制、脱发等，但患者可耐受。「结论」ＥＬＦＣ     

惰性B淋巴瘤的临床特征及预后分析

目的探讨惰性B淋巴瘤患者的临床特征及预后。方法选择接受化疗的71例惰性B淋巴瘤患者作为惰性组,同期选择弥漫性大B细胞淋巴瘤45例作为侵袭组,记录2组患者的临床特征、IL-6、IL-10表达水平及预后,并进行相关性分析。结果2组的性别、临床分期、体能状态、FLIPI分级等差异无统计学意义(P>0.05),2组的结外受累、骨髓侵犯、年龄等差异有统计学意义(P<0.05)。惰性组的IL-6与IL-10阳性表达率显著低于侵袭组(P<0.05)。惰性组中,化疗后完全缓解54例,部分缓解8例,病情稳定5例,病情进展4例,总有效率为87.3%;二元Logistic回归显示结外受累、骨髓侵犯、IL-6与IL-10阳性率均为影响预后的危险因素(P<0.05)。结论惰性B淋巴瘤患者年龄较大,少伴随有结外受累、骨髓侵犯,IL-6与IL-10表达量比较低。结外受累、骨髓侵犯、IL-6与IL-10阳性率均为影响惰性B淋巴瘤患者预后的危险因素。     

Central nervous system occurrence in elderly patients with aggressive lymphoma and a long-term follow-up.

BACKGROUND: Secondary central nervous system (CNS) involvement by aggressive lymphoma is a well-known and dreadful clinical complication. The incidence and risk factors for CNS manifestation were studied in a large cohort of elderly (>60 years) patients with aggressive lymphoma. PATIENTS AND METHODS: In all, 444 previously untreated patients were randomized to receive 3-weekly combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone or cyclophosphamide, mitoxantrone, vincristine and prednisone (CNOP) (doxorubicin substituted by mitoxantrone) chemotherapy with or without filgrastim. Prophylactic intrathecal methotrexate was given to patients with lymphoma involvement of bone marrow, testis and CNS near sites. RESULTS: In all 29 of 444 (6.5%) developed CNS disease after a median observation time of 115 months. CNS was the only site of progression/relapse in 13 patients while part of a systemic disease manifestation in 16 patients. In univariate risk factor analysis, CNS occurrence was associated with extranodal involvement of testis (P = 0.002), advanced clinical stage (P = 0.005) and increased age-adjusted International Prognostic Index score (aaIPI; P = 0.035). In multivariate analysis, initial involvement of testis remained significant and clinical stage was of borderline significance. The median survival time was 2 months after presentation of CNS disease. CONCLUSION: A significant proportion of elderly patients with advanced aggressive lymphoma will develop CNS disease. CNS occurrence is related to testis involvement, advanced clinical stage and high aaIPI and the prognosis is dismal.     

一种新的淋巴瘤亚型:bcl-2和myc易位的双击淋巴瘤

 双击淋巴瘤（DHL）特征介于弥漫大B细胞淋巴瘤（DLBCL）和伯基特淋巴瘤（BL）之间,通常伴有myc基因断裂和其他重现性染色体断裂的疾病,常见myc和bcl-2基因的易位。其临床表现具有乳酸脱氢酶升高、骨髓受累、Ann Abort分期晚期、B症状、结外受累、侵犯中枢神经系统等特征。因与DLBCL和BL有部分重叠,所以依靠病理诊断很难将其区分出来,目前主要的诊断方法为G显带染色体核型分析、荧光原位杂交（FISH）检测以及免疫组织化学技术。DHL对于DLBCL的标准化疗方案反应较差,预后不佳,中位生存期仅为0.2～1.5年。目前DHL尚无较好的治疗方法,主要方案为RCHOP、RICE、RCVD、甲氨蝶呤预防中枢神经系统受累、大剂量化疗联合骨髓移植等。     

High-dose methotrexate-leucovorin rescue therapy: selected application in non-Hodgkin's lymphoma

Methotrexate with leucovorin rescue (HDMTX-LV rescue), has been used to treat solid tumors and non-Hodgkin's lymphomas (NHL). We studied the use of HDMTX-LV rescue in patients with widespread NHL with histologic diagnosis of diffuse poorly differentiated lymphocytic and diffuse histiocytic including involvement of the central nervous system (CNS) and/or bone marrow. The prognosis with conventional chemotherapy is extremely poor. Three patients have bone marrow involvement, 2 patients CNS, and 2 both. These patients were unresponsive to conventional chemotherapy and had a rapid progression of their disease. Therapy with HDMTX-LV rescue induced responses in 5 patients: 2 patients achieved a complete remission and three a partial remission. Regression of CNS involvement was observed in 3 patients; bone marrow toxicity was not observed. Only 1 patient failed to respond. These data suggest that HDMTX-LV rescue may be useful as primary therapy in lymphoma patients with CNS and/or bone marrow involvement.     

37例原发骨恶性淋巴瘤的临床特点及预后因素分析

探讨原发骨恶性淋巴瘤（primary bone lymphoma,PBL）的临床特点及其与预后的相关性。方法:回顾性分析1995年6月至2009年5月本院收治的37例PTL患者的临床资料,以Kaplan-Meier法绘制生存曲线,用Log-rank检验进行单因素分析,多因素分析采用Cox回归模型以评估独立的预后因素。结果:37例患者的中位发病年龄为61（18～85）岁,首发症状主要表现为骨痛,局部软组织肿胀、肿块形成和病理性骨折。78%患者的病理类型为弥漫大B细胞淋巴瘤。经化疗和/或放疗,18例完全缓解（complete response,CR）,13例部分缓解（partial response,PR）,3例稳定（stable disease,SD）,2例进展（progressive disease,PD）。中位随访时间32（7～171）个月,5年和10年总生存率分别为59.5%和43.2%。患者接受4周期以上化疗,B细胞淋巴瘤加用利妥昔单抗者疗效较好。多因素分析显示:Ann Arbor分期、B症状、年龄和结外受侵数是PBL的独立预后因素。结论:PBL应采取综合治疗,同时给予蒽环类药物为主的全身化疗,B细胞淋巴瘤首选利妥昔单抗联合化疗,给予帕米膦酸盐治疗骨病变。Ann Arbor分期、B症状、年龄和结外受侵数为PBL预后的独立影响因素。      

美罗华联合Hyper-CVAD/MTX+Ara-C方案治疗高危青年伯基特淋巴瘤的疗效观察（附6例）

目的:分析美罗华联合Hyper-CVAD/MTX+Ara-C方案治疗高危青年伯基特淋巴瘤的治疗效果。方法:总结2014年10月至2016年10月,我院收治的6例伯基特淋巴瘤患者的特征，均采用美罗华联合Hyper-CVAD/MTX+Ara-C方案化疗，历时4个周期共8个疗程，病程中腰穿及鞘注。结果:6例初诊患者临床分期(Arbor分期)Ⅲ期1例，Ⅳ期5例；首发部位多见于腹部包块及浅表淋巴结，均有B症状，乳酸脱氢酶（LDH）水平偏高，骨髓侵犯3例，中枢神经系统侵犯1例，有结外侵犯者3例。总疗程结束后评估，CR 5例，PR 1例，平均缓解期2.3个月。随访2.5年，5例患者病情稳定，1例死亡。结论:美罗华联合Hyper-CVAD/MTX+Ara-C方案治疗高危青年伯基特淋巴瘤有一定效果，患者对联合化疗的耐受性尚可。     

NK/T-cell lymphomas 'nasal type': an Italian multicentric retrospective survey.

OBJECTIVE: To evaluate the clinical characteristics and outcome of NK/T-cell lymphoma 'nasal type' developed in Italian patients. PATIENTS: Between 1997 and 2004, 26 new cases of NK/T-cell lymphoma 'nasal type' were diagnosed in 10 Italian Hematology institutions. RESULTS: All patients were Caucasian, male/female ratio was 19/7, with a median age of 50 years (range 20-80). In 23 cases presentation at the onset was in the nasal cavity or adjacent structures, in two cases the lymphoma onset with skin lesions was followed successively by rhynopharyngeal dissemination, while the remaining case had bone marrow and lymph node involvement followed by oro-pharyngeal involvement. Regarding the stage of disease: 12 patients were in stage I; six in stage II; eight in stage IV. Diagnosis was based on the finding of a NK/T-cell phenotype at the histological and immunophenotypic examination of oropharyngeal or cutaneous lesions. All patients but one were treated with chemotherapy, alone in nine cases or associated to radiotherapy in 14 cases; two patients had chemotherapy, radiotherapy and surgery, while one patient underwent only surgery. Chemotherapy was anthracycline-based in 17 out of 25 cases. In those patients in whom radiotherapy was performed, radiation dosages ranged between 36 Gy and 47.5 Gy, with a median dosage of 40 Gy. Nine patients (34%) were responsive to the treatments: six patients obtained a complete remission and other three a partial remission. The remaining 17 patients resulted refractory or presented a limited response to therapy. The median disease-free survival was 14 months and the median overall survival time was 9 months. CONCLUSION: The results of this retrospective survey confirmed that NK/T-cell lymphoma 'nasal type' is a very rare lymphoma in the Italian population, and it is characterized by a very bad prognosis. Due to the rarity of this disease, a standardized therapeutic approach is lacking. More data are needed to know the epidemiology of this kind of lymphoma in Europe.     

Clinical aspects of human immunodeficiency virus-related lymphoma.

As patients with human immunodeficiency virus infection live longer because of better antiretroviral therapy and infection prophylaxis, the incidence of non-Hodgkin's lymphoma has increased. The risk increases inversely with CD4 count--the most widely used surrogate marker for progressive immune suppression. Zidovudine itself does not appear to be a risk factor. Patients frequently present with extranodal advanced disease. The central nervous system is the primary site in 10% to 20% of cases. Important prognostic factors are performance status, a prior history of acquired immunodeficiency syndrome, and bone marrow involvement. Therapy is complicated by underlying immunosuppression, opportunistic infection, and poor bone marrow reserve. Progress has been made using colony-stimulating factors and less intensive chemotherapy regimens in systemic non-Hodgkin's lymphoma. Treatment of primary central nervous system lymphoma with radiation therapy has not improved survival.     

原发结内外周T细胞淋巴瘤19例临床特征及预后分析

 目的　分析原发结内外周T细胞淋巴瘤（PTCL）的临床特点、治疗和预后。方法　回顾性分析19例原发结内PTCL患者的临床资料、治疗反应以及预后因素。结果　19例患者中位发病年龄54岁,男女比例2.17∶1,其中94.7 %（18／19）为Ⅲ～Ⅳ期,84.2 %（16／19）有B症状,84.2 %（16／19）有结外器官受累,57.9 %（11／19）有骨髓浸润。化疗完全缓解（CR）率36.8 %（7／19）,2年总生存（OS）率47.4 %,2年无进展生存（PFS）率25 %。预后分析显示,结外侵犯数量（EN）≥2个、美国东部肿瘤协作组（ECOG）体能状态评分≥2分、国际预后指数（IPI）评分＞2分以及β2-微球蛋白（β2-MG）升高为不良预后因素。结论　原发结内PTCL是一类高度侵袭的异质性T细胞淋巴瘤,化疗效果差,多项因素提示不良预后。     

Discordant bone marrow involvement in diffuse large-cell lymphoma: a distinct clinical-pathologic entity associated with a continuous risk of relapse

From 1975 to 1988, 50 patients with lymph node biopsy-documented diffuse large-cell lymphoma (DLCL) presented with bone marrow involvement. Twenty-four patients (48%) had large-cell lymphoma (LCL) in the bone marrow and were compared with 19 (38%) patients who had small cleaved-cell lymphoma (SCCL) in the marrow. Additionally, seven patients (14%) had mixed small- and large-cell lymphoma (ML) in the marrow. Patients who had LCL marrow involvement were younger (P less than .02) and more frequently had elevated lactic dehydrogenase (LDH) levels (P less than .001), high tumor burden (P less than .01), and more sites of extranodal disease (P less than .05) than those with SCCL in the marrow. The complete response (CR) rate to multiagent chemotherapy was 16.7% in the LCL group and 89.4% in the SCCL group (P less than .001). One third of the patients with LCL in the marrow developed CNS involvement, compared with only one patient in the SCCL group (P = .06). Overall 5-year survival was 79% in patients with SCCL marrow involvement, compared with only 12% in patients with LCL in the marrow (P = .002). Despite a high CR rate, patients with marrow involved by SCCL were at a high continuous risk of relapse with only a 30% failure-free survival at 5 years. We conclude that bone marrow involvement with LCL predicts for extremely poor prognosis with low response rate and short survival. Patients with SCCL in the bone marrow have a high rate of CR and a high rate of 5-year survival; however, there is a high risk of late relapse, and only 15% are in a continuous remission at 8 years.