DICE作为二线方案治疗难治或复发性非霍奇金淋巴瘤

目的:观察DICE作为二线方案治疗难治或复发性非霍奇金淋巴瘤(NHL)有效性及不良反应耐受性。方法:采用DICE方案治疗28例复发或难治性非霍奇金淋巴瘤。其中,复发组16例,难治组12例并探讨足三里穴位封闭或粒细胞集落刺激因子(G-CSF)预防化疗对造血系统的抑制作用。结果:28例中,完全缓解CR7例(25.0%),部分缓解PR8例(28.6%),有效率53.6%。复发组的有效率明显高于难治组(10/16比4/12;P<0.01)。乳酸脱氢酶(LDH)升高12例中CR2例,LDH正常组16例CR5例,有显著性差异(P<0.01)。DICE方案的不良反应主要表现为恶心呕吐、脱发和可逆性骨髓抑制,患者均能耐受,无1例出现治疗相关性死亡。结论:DICE方案对复发性NHL有效,但对难治性NHL相对无效,提示复发性和难治性NHL可能有不同的生物学行为,对两者应该选择不同的治疗措施,LDH可以作为NHL化疗是否敏感的指标之一。     

ESHAP方案治疗复发性或难治性非霍奇金淋巴瘤的临床观察

目的:观察ESHAP方案治疗难治性或复发性非霍奇金淋巴瘤(NHL)的疗效及不良反应.方法:采用足叶乙甙、甲基强的松、顺铂、阿糖胞苷联合治疗20例NHL观察其治疗及不良反应.结果:20例中,完全缓解(CR)5例,部分缓解(PR)10例,总有效率(RR)75%.难治性6例中CR 1例,PR 3例,RR 67%.复发性14例中CR 4例,PR 7例,RR 79%.ESHAP方案的主要不良反应为骨髓抑制,白细胞减少的发生率为100%,Ⅲ-Ⅳ度为55%,血红蛋白及血小板减少的发生率分别为35%和55%,胃肠道反应发生率为45%,脱发发生率为55%,患者均可耐受.结论:ESHAP方案治疗复发性或难治性NHL是一种较理想的治疗方案.     

IPE方案治疗难治性非霍奇金淋巴瘤20例近期疗效观察

恶性淋巴瘤对化疗通常有效,但某些病例却对常用化疗抗拒或退缩后很恢复发,被称为"难治性淋巴瘤".近年我们采用IPE方案治疗20例难治性非霍奇金淋巴瘤(NHL),取得较好疗效,现将结果报告如下.     

IMEP方案治疗复发性非霍奇金淋巴瘤28例疗效分析

我院 1999年 8月— 2 0 0 2年 8月应用 IFO(异环磷酰胺 )、Mx(米托蒽醌 )、VP1 6 (足叶乙苷 )、P(强的松 )组成 IMEP方案治疗复发的非霍奇金淋巴瘤取得较好的疗效 ,现分析报告如下。1　临床资料1.1　一般资料　本组 IMEP方案 2 8例 ,男性 17例 ,女性 11例 ,年龄 2 1岁～6 5岁 ,平均年龄 4 1.2岁。1.2　诊断依据　所有病例经临床、血液学、骨髓象及淋巴结组织活检病理学检查确诊 ,按国际工作分类 :中度恶性 11例 ,其中弥漫型大细胞 (裂 /无裂 ) 3例 ,滤泡型大细胞为主型 6例 ,弥漫型小裂细胞 2例 ;高度恶性 17例 ,其中免疫母细胞型 10…     

IEC方案治疗难治性非霍奇金淋巴瘤的临床研究

目的:探讨IEC方案治疗难治性非霍奇金淋巴瘤的临床疗效.方法:1998年12月～2002年12月应用IEC方案治疗难治性非霍奇金淋巴瘤23例,共用59个周期,每例2～5个周期,平均2.6个周期.结果:化疗结束后完全缓解4例,部分缓解11例,稳定5例,进展3例,总有效率(CR+PR)65.2%.4周后复查完全缓解4例,部分缓解10例,稳定6例,进展3例,总有效率(CR+PR)60.9%.骨髓抑制是主要不良反应,但较其它一些二、三线方案轻,临床易于处理,未出现出血性膀胱炎.结论:IEC方案治疗难治性非霍奇金淋巴瘤疗效与安全性均较高,是治疗难治性非霍奇金淋巴瘤的较好方案.     

奥沙利铂联合阿糖胞苷及地塞米松治疗难治性或复发性非霍奇金淋巴瘤

目的 观察奥沙利铂(L-OHP)联合阿糖胞苷(Ara-C)及地塞米松(DXM)对难治性或复发性非霍奇金淋巴瘤(NHL)的疗效及患者不良反应.方法 L-OHP 130 mg/m2,静脉滴注,第1天;Ara-C 2000 mg/m2,静脉滴注,1次/12h,第2天;DXM 40 mg/d,静脉推注,第1天至第4天.每3～4周为1个化疗周期,治疗22例难治性或复发性NHL患者,每例患者治疗≥3个周期评价疗效.结果 22例中的1例于化疗第1周期后死于疾病进展.可评价的21例中13例(61.9%)治疗有效,其中完全缓解(CR)9例(42.9%),部分缓解(PR)4例(19.0%).21例化疗共86个周期,患者不良反应主要表现为轻度胃肠道反应78次(90.7%),中性粒细胞缺乏41次(47.7%),血小板减少61次(70.9%),贫血33次(38.4%).可逆性周围神经病变12例(57.1%).未发现明显肾功能异常者.结论 L-OHP联合Ara-C及DXM对难治性或复发性NHL有较好的近期疗效,其不良反应可以耐受.     

IEC方案治疗难治性非霍奇金淋巴瘤的临床研究

目的：探讨IEC方案治疗难治性非霍奇金淋巴瘤的临床疗效。方法：1998年12月～2002年12月应用IEC方案治疗难治性非霍奇金淋巴瘤23例，共用59个周期，每例2～5个周期，平均2．6个周期。结果：化疗结束后完全缓解4例，部分缓解11例，稳定5例，进展3例，总有效率(CR PR)65．2％。4周后复查完全缓解4例，部分缓解lO例，稳定6例，进展3例，总有效率(CR PR)60．9％。骨髓抑制是主要不良反应，但较其它一些二、三线方案轻，临床易于处理，未出现出血性膀胱炎。结论：IEC方案治疗难治性非霍奇金淋巴瘤疗效与安全性均较高，是治疗难治性非霍奇金淋巴瘤的较好方案。     

IHEP方案治疗难治性复发性非霍奇金淋巴瘤近期疗效观察

目的 探索难治性复发性非霍奇金淋巴瘤（ＮＨＬ）的有效化疗方案。方法 １８例难治性复发性ＮＨＬ患者，其中男性１４例，女性４例；年龄９￣７５岁，中位年龄４５岁；属难治性者１２例，复发性者６例；均有病理学诊断。用ＩＨＥＰ方案化疗，即异环磷酰胺９ＩＦＯ）１．５／ｍ＾２静滴，第１至５天；阿霉素（ＡＤＭ）３０￣４０ｍｇ／ｍ＾２静滴，第１天；足叶乙甙（Ｖｐ１６）０．１／ｍ＾２静滴，第１至５天；强的松（ＰＤＮ）１     

IHEP方案治疗难治性复发性非霍奇金淋巴瘤近期疗效观察

探索难治性复发性非霍奇金淋巴瘤 (NHL)的有效化疗方案。方法　 18例难治性复发性NHL患者 ,其中男性 14例 ,女性 4例 ;年龄 9～ 75岁 ,中位年龄 45岁 ;属难治性者 12例 ,复发性者 6例 ;均有病理学诊断。用IHEP方案化疗 ,即异环磷酰胺 (IFO)1.5 /m2 静滴 ,第 1至 5天 ;阿霉素 (ADM ) 30～ 40mg/m2 静注 ,第 1天 ;足叶乙甙 (Vp16 ) 0 .1/m2 静滴 ,第 1至 5天 ;强的松 (PDN) 10 0mg/日口服 ,第 1至 5天 ;2 1～ 2 8天为一个疗程。结果　 18例可评价疗效的患者中 ,CR 2例 ,PR 12例 ,NC 3例 ,PD 1例。CR PR为 14例。总有效率 77.8%。主要毒副反应为骨髓抑制、脱发、消化道反应 ,亦见轻度心脏毒性。结论　IHEP方案治疗难治性复发性NHL是疗效较满意的方案。     

MINE-ESHAP联合方案治疗难治或复发性非霍奇金淋巴瘤28例

 目的　探讨MINE-ESHAP联合方案治疗难治性或复发性非霍奇金淋巴瘤（NHL）的疗效。方法　采用MINE-ESHAP联合方案治疗难治性或复发性NHL 28例。结果　28例患者中,CR 11例（39.3 %）,PR 6例（21.4 %）,SD 5例（17.9 %）,进展或恶化5例（17.9 %）,中位生存时间28.5个月。1例死于骨髓抑制期感染（3.6 %）。不良反应主要为消化道症状和骨髓抑制。结论　MINE-ESHAP方案对部分难治性或复发性NHL患者有效,不良反应可以耐受,可用于对其他化疗方案无效的难治性或复发性NHL。     

异环磷酰胺为主治疗复发或难治性非霍奇金淋巴瘤

采用异环磷酰胺（IFO）为主联合化疗方案治疗复发或难治性非霍奇金淋巴瘤（NHL）27例，总有效率63．00％，且毒性性能耐受，可作为一线治疗失败后的解救方案。     

Results of a Salvage Regimen in Refractory or Relapsed Non-Hodgkin's Lymphoma

After therapy with adriamycin-containing regimens, relapsed or refractory non-Hodgkin's lymphomas (NHL) have a very poor prognosis. Although high dose chemotherapies are widely employed, their related costs and the controversial results achieved justify the development of new second-line conventional therapies. Forty-three patients with relapsed or refractory NHL were consequently treated with an outpatient polychemotherapy schedule including ifos-famide, mitoxantrone and etoposide on day 1, and vindesine, cisplatinum and cytosine ara-binoside on day 15. The courses were repeated on day 29. All of the patients were pretreated with at least one chemotherapy regimen. Twenty-two patients had diffuse large cell lymphoma, 8 had bone marrow involvement, and 17 altered baseline lactate dehydrogenase (LDH) values. After a median number of 4 cycles (range 2-8), we registered 20 complete (46%) and 4 partial remissions, for an overall remission rate of 56% (95% confidence interval: 40-71%). All of the responses occurred in patients who had achieved at least partial remission during first-line therapy. Four patients are long term responders after 31, 39, 49 and 52 months, and are possibly cured. Univariate analysis of prognostic factors showed that baseline LDH values and response to front-line therapy significantly affected both time to disease progression and survival, whereas the number of previous treatments given, significantly affected only the time to progression. Therapy was administered in an out-patient setting and no life-threatening toxicity was observed. Side effects consisted of nausea/vomiting, alopecia and reversible myelosuppression. The results suggest that different treatment strategies for relapsed and refractory patients should be considered on the basis of prognostic factors. The proposed schedule may be potentially curative in a subgroup of relapsed patients at better risk; poor risk refractory patients should be considered for investigational trials involving high-dose chemotherapy.     

VID方案治疗复发性及难治性恶性淋巴瘤

[目的]探讨用异环磷酰胺（IFO）、威猛（VM26）、地塞米松（DXM,VID方案）治疗复发性难治性恶性淋巴瘤疗效。［方法］以VID方案治疗复发性难治性恶性淋巴瘤20例。〔结果〕完全缓解4例（20％）,部分缓解13％（65％）,无效3例（15％）,总有效率85％。［结论］认为VID方案对复发性及难治性淋巴瘤有一定疗效。     

Treatment of Relapsed or Refractory Aggressive Non-Hodgkin Lymphoma with Two Ifosfamide-Based Regimens,IMVP and ICE

Abstract

We report the outcomes of 45 patients with relapsed or refractory aggressive non-Hodgkin's lymphoma (NHL) treated with a combination of ifosfamide, carboplatinum and etoposide (ICE) and 28 patients treated with a combination of ifosfamide, methotrexate and etoposide (IMVP) during two 5-year periods. The response rate (RR) to ICE was 47%, 2-year overall survival (OS) 31% and 2-year event-free survival (EFS) 22%. These results were similar to those obtained with IMVP (RR 39%, 2-year OS 23%, 2-year EFS 13%; p=0.355 for RR, 0.275 for OS, 0.668 for EFS). Higher IPI scores and refractoriness to treatment were negative prognostic factors, immunophenotype (B vs. T) had no influence on prognosis. Changing from IMVP to ICE does not substantially improve the outcome of patients with relapsed or refractory aggressive NHL. Patients with relapsed/refractory aggressive B-NHL do not have a superior out-come in comparison to those with T-NHL if treated with chemotherapy alone.     

GDP方案治疗复发和难治性非霍奇金淋巴瘤的疗效观察

目的 观察GDP方案(吉西他滨、顺铂、地塞米松)治疗复发和难治性非霍奇金淋巴瘤(NHL)的疗效和不良反应.方法 回顾性分析用GDP方案治疗的19例复发和难治性非霍奇金淋巴瘤患者的临床资料,包括治疗后缓解情况、复发率、生存率以及出现的不良反应.结果 19例患者均可评价疗效和不良反应,其中完全缓解(CR)5例,部分缓解(PR)5例,稳定(SD)4例,进展(PD)3例,总有效率为52.6%.1年总生存率为48.8%.主要不良反应为骨髓抑制,其中Ⅲ~Ⅳ度中性粒细胞减少发生率为15.8%,Ⅲ~Ⅳ度血小板减少发生率为21.1%,恶心呕吐反应一般对症治疗可恢复,无治疗相关死亡.结论 GDP方案治疗难治和复发性非霍奇金淋巴瘤疗效好,副作用可以耐受,是一种值得进一步推广的挽救治疗方案.     

GemOX方案治疗老年复发难治性非霍奇金淋巴瘤疗效观察

目的 探讨吉西他滨联合奥沙利铂(GemOX方案)治疗老年复发难治性非霍奇金淋巴瘤(NHL)的疗效和毒副反应.方法全组30例患者均接受GemOX方案化疗:吉西他滨1000 mg/m2,d1.8,静脉滴注;奥沙利铂130 mg/m2,d1,静脉滴注.每21 ～28 d为1个周期,完成2个周期化疗后评价疗效,完成1个周期化疗...     

ACES方案治疗难治性或复发性非霍奇金淋巴瘤的疗效观察

目的 应用阿糖胞苷(Ara-c)、顺铂(cisplatin)、足叶乙甙(etoposide),类固醇激素(storid)联合化疗治疗难治性或复发性非霍奇金淋巴瘤(NHL),观察疗效及毒副反应.方法 12例难治性或复发性NHL,给予Ara-c 500 mg,d5,顺铂40 mg,d1-3,足叶乙甙(VP16-213)100 mg,d1-4,Dex 40 mg,d1-5联合化疗.结果 总有效率(CR PR)为66.6%.毒副反应主要是骨髓抑制,经G-CSF治疗均可恢复.结论 与NHL经典方案无交叉耐药的ACES补救方案是治疗难治性或复发性非霍奇金淋巴瘤有效、安全的治疗方案.     

我国复发难治性淋巴瘤治疗策略分析

对比分析国内外淋巴瘤权威指南中关于不同类型复发难治性淋巴瘤的诊治信息,并收集国内外复发难治性淋巴瘤诊治的循证医学证据.与国外指南相比,我国的复发难治性淋巴瘤治疗方案包括病种较少;内容相对简单,操作力不强;未注明循证医学研究证据,可参考性有待提高.我国复发难治性淋巴瘤的定义、诊断标准有待规范,临床实践指南内容有待扩充,应开展复发难治性淋巴瘤的高质量临床研究,充分收集循证医学研究证据,提高临床实践指南的可操作性,规范复发难治淋巴瘤诊治.     

Ibrutinib Monotherapy in Relapsed or Refractory,Transformed Diffuse Large B-cell Lymphoma

BackgroundHistologic transformation to diffuse large B-cell lymphoma (tDLBCL) occurs in a significant proportion of indolent lymphomas. However, few studies of novel agents inform its management, particularly when relapsed after or refractory (R/R) to prior treatment.Patients and MethodsWe prospectively evaluated ibrutinib monotherapy in pathologically documented patients with R/R tDLBCL in a single-arm study. The primary endpoint was overall response rate.ResultsTwenty patients who had received a median of 4 (range, 2-9) prior lines of therapy overall (median, 2.5; range, 1-9 for tDLBCL) were treated. The overall response rate was 35%, including complete responses in 15%. The median progression-free survival and overall survival were 4.1 months (95% confidence interval, 2.4-6.2 months) and 22.4 months (95% confidence interval, 7.5 months to not reached), respectively. Disease control > 2 months was seen in 75% and > 1 year in 15%. Response was associated with either low tumor bulk or low metabolic tumor volume (P = .05) but not with antecedent lymphoma histology (P = 1.0). Treatment-related adverse events were consistent with prior studies of ibrutinib.ConclusionsIbrutinib showed low toxicity and meaningful efficacy in R/R tDLBCL, including short-term disease control in most cases. Results demonstrate the potential utility of ibrutinib in this challenging clinical setting, including as a potential bridge to more definitive treatments.