改良的ProMACE／CytaBOM方案治疗非霍奇金淋巴瘤的疗效观察

目的：探讨改良的ProMACE／CytaBOM方案治疗高度恶性非霍奇金淋巴瘤及中度恶性非霍奇金淋巴瘤的疗效。方法：采用改良的ProMACE／CytaBOM方案治疗16例高度恶性非霍奇金淋巴瘤及中度恶性非霍奇金淋巴瘤患者，其中高度恶性9例，7例为初发患者，2例为复发患者；中度恶性7例为复发患者。结果：7例高度恶性非霍奇金淋巴瘤及中度恶性复发性非霍奇金淋巴瘤达到完全缓解（CR率4．3．7％），6例达到部分缓解（PR率37．5％），总有效率为81．2％；目前8例仍生存，其中生存时间最长达42个月（2例），仍处于CR期。毒副作用主要为消化道症状、轻度肝功能异常以及骨髓抑制。结论：改良的ProMACE／CytaBOM方案对部分高度恶性非霍奇金淋巴瘤及中度恶性复发性非霍奇金淋巴瘤患者效果好，毒副作用较轻，值得推广使用。     

ProMACE/CytaBOM方案治疗中高度非霍奇金淋巴瘤

目的 :研究ProMACE/CytaBOM方案治疗中、高度恶性非霍奇金淋巴瘤的临床疗效及不良反应。方法 :采用ProMACE/CytaBOM方案治疗非霍奇金淋巴瘤 34例。其中弥漫性大细胞型 2 1例 ,弥漫性小裂细胞型 3例 ,弥漫性大小细胞混合型 4例 ,免疫母细胞型 3例 ,淋巴母细胞型 2例 ,小无裂细胞型1例。恶性程度为中高度。分期为Ⅱ～Ⅳ期。结果 :CR 2 3例 ,占 67.6% ;PR 6例 ,占 17.6% ;有效率为85.3%。主要毒副作用为骨髓抑制和胃肠道反应。结论 :ProMACE/CyatBOM方案治疗中高度恶性非霍奇金淋巴瘤近期疗效确切 ,毒副作用可耐受 ,值得临床推广。     

ProMACE-CytaBOM方案与CHOP方案治疗非霍奇金淋巴瘤的随机对照研究

背景与目的:CHOP方案一直是治疗中、高度恶性非霍奇金淋巴瘤(non鄄Hodgkin蒺slymphoma,NHL)的基本方案,近年有文献报道ProMACE鄄CytaBOM方案可以提高中、高度恶性NHL的完全缓解(completeresponse,CR)率及生存率。本研究中我们比较ProMACE鄄CytaBOM方案与CHOP方案治疗中、高度恶性NHL的疗效与安全性,为中、高度恶性NHL的规范治疗提供依据。方法:选择经病理组织学证实的中、高度恶性NHL的患者146例,随机分为ProMACE鄄CytaBOM组和CHOP组两组,分别采用上述两种方案治疗。两组生存率采用Kaplan鄄Meier法分析,组间比较采用χ2检验。结果:ProMACE鄄CytaBOM组CR29例(39.7%),部分缓解(partialresponse,PR)28例(38.4%),缓解率(responserate,RR,CR+PR)为78.1%(57/73);CHOP组CR23例(31.5%),PR21例(28.8%),RR为60.3%(44/73);两组比较有显著性差异(P<0.05)。ProMACE鄄CytaBOM组患者1、3、5年生存率分别为89.3%、76.2%和45.7%,CHOP组分别为82.1%、51.4%和32.3%,两组比较有显著性差异(P<0.05)。两组出现的主要不良反应是白细胞下降、血小板下降及恶心等,两组比较无显著性差异(P>0.05)。两组各有1例治疗相关性死亡病例。结论:与CHOP方案相比,ProMACE鄄CytaBOM方案疗效较好,不良反应可以耐受,可作为治疗中、高度恶性NHL的     

ProMACE-CytaBOM方案治疗难治性及复发中高度恶性非霍奇金淋巴瘤的对照研究

目的:观察ProMACE CytaBOM方案治疗复发及难治性中高度恶性非霍奇金淋巴瘤(non Hodgkin’slymphoma,NHL)的临床疗效及毒副反应,并与DICE方案比较。方法:41例复发及难治性中高度恶性NHL患者随机分为两组:治疗组20例,采用Pro MACE CytaBOM方案治疗;对照组21例,采用DICE方案治疗。结果:治疗组与对照组两组CR率分别为35.0%和28.6%,χ2=0.196,P=0.658;两组总有效率分别为70.0%和71.4%,χ2=0.010,P=0.920;经过中位15个月(5～27个月)的随访,两组1、2年总生存率及中位生存期分别为65.0%、34.7%、19个月和64.8%、34.6%、16个月,χ2=0.210,P=0.645;两组1、2年无疾病进展生存率及中位疾病进展时间分别为40.0%、11.4%、11个月和41.9%、17.4%、11个月,χ2=0.000,P=0.964,差异均无统计学意义。两组毒副反应亦相似。结论:ProM ACE CytaBOM方案是复发及难治性非霍奇金淋巴瘤患者的一个有效的解救治疗方案。     

Hyper-CVAD/MA方案治疗复发或难治性非霍奇金淋巴瘤临床分析

目的:评价hyper-CVAD/MA方案治疗复发或难治性非霍奇金淋巴瘤的疗效、安全性和不良反应. 方法: 24例复发或难治性非霍奇金淋巴瘤患者采用hyper-CVAD/MA方案治疗.化疗每28天循环1个周期,下一周期治疗前评价疗效,每周评价不良反应.结果: 24 例患者中,总有效率为75% ,其中CR 11例(45.83%),PR 7例(29.17%), 1例(4.1%) 患者因疾病进展死亡.1年无进展生存(PFS)率为50.11%,1年总生存(OS)率为79.8%.不良反应主要为化疗相关的血液学不良反应,均可耐受.结论: hyper-CVAD/MA方案治疗复发或难治性非霍奇金淋巴瘤,近期疗效满意,治疗相关不良反应易于控制,值得临床推广.     

E-CHOP方案治疗中高度恶性非霍奇金淋巴瘤的疗效观察

目的:观察E-CHOP方案对中高度恶性非霍奇金淋巴瘤的治疗效果。方法:应用E-CHOP方案治疗28例中高度恶性非霍奇金淋巴瘤。E-CHOP方案:环磷酰胺750mg/m2,d1;长春新碱1.4mg/m2,d1;表阿霉素50mg/m2,d1;强的松60mg/(m2.d),d1～d5;足叶乙甙100mg/d,3～5d。每21天为1周期,共进行6～8个周期。结果:CR率为68%(19/28),PR率为17%(5/28),NC率为7%(2/28),PD率为7%(2/28),总有效率(CR PR)为85%。主要毒副作用为骨髓抑制,其次为恶心呕吐,脱发,较少的是口腔粘膜损害,全部病例无化疗相关死亡。结论:E-CHOP方案有较高的有效率,且耐受性良好,可以作为中高度淋巴瘤患者的一线治疗方案。     

PEP-C节拍化疗方案治疗复发和难治性非霍奇金淋巴瘤23例探讨

目的:评价PEP-C节拍化疗方案治疗复发和难治性非霍奇金淋巴瘤的疗效和不良反应.方法:回顾性分析厦门大学附属中山医院采用PEP-C节拍化疗方案治疗的23例复发和难治性非霍奇金淋巴瘤患者的临床资料.结果:所有23例患者均可评价疗效和不良反应,完全缓解(CR)率30.4%(7/23),部分缓解率(PR)30.4%(7/23),总的客观有效率(RR)60.8%(14/23).低度恶性非霍奇金淋巴瘤与中高度恶性非霍奇金淋巴瘤有效率分别为81.8%(9/11)、41.7%(5/12),完全缓解率分别为45.5%(5/11)、16.7%(2/12)(P<0.05).国际预后指数(IPI)低危组(IPI评分0～2分)与高危组(IPI评分3～5分)有效率分别为60.0%(9/15)、62.5%(5/8),完全缓解率分别为33.3%(5/15)、25.0%(2/8)(P>0.05).主要不良反应为骨髓抑制、恶心呕吐及腹泻,经过治疗均可恢复,无治疗相关死亡.结论:PEP-C节拍化疗方案对于复发难治性非霍奇金淋巴瘤疗效肯定,不良反应较低,特别适合不能耐受强烈化疗的患者,值得在更多病例中进一步研究.     

EPOCH方案治疗复发性B细胞非霍奇金淋巴瘤的临床护理

目的:探讨EPOCH方案治疗复发性非霍奇金淋巴瘤的治疗与护理方法。方法:复发非霍奇金淋巴瘤患者30例,行EPOCH方案化疗,在常规护理的同时,加强心理护理和化疗毒副反应的护理。结果:30例患者CR9例(30%),PR10例(33.3%),总有效率63.3%(19/30)。结论:EPOCH方案是治疗复发性B细胞非霍奇金淋巴瘤的有效解救化疗方案,患者耐受性好,毒副反应小。心理护理减少了患者对化疗的恐惧感,化疗后的护理使治疗能顺利完成,增强了治疗效果。     

GDP方案治疗侵袭性复发性或难治性非霍奇金淋巴瘤

目的:探讨吉西他滨联合顺铂、地塞米松(GDP方案)治疗侵袭性复发性或难治性NHL的疗效和毒副作用。方法:从2003年5月到2008年5月,共治疗53例侵袭性复发难治的NHL患者,其中复发和难治者分别为35例和18例。B细胞和T细胞来源分别为30例和23例。中度和高度侵袭性NHL分别为44例和9例,分别接受过CHOP方案或CHOP类方案和HyperCVAD方案治疗至少2个周期,既往接受过局部放疗22例。所有患者采用GDD方案挽救化疗,3~4周为一个周期,共2~6个周期。结果:53例患者接受平均4.4个周期化疗(共231个周期),所有患者可评价疗效和不良反应。完全缓解(CR)率24.5%(13/53),总有效率(RR)为52.8%(28/53)。其中难治者CR率5.6%(1/18),RR率为33.3%(6/18),复发者CR率为34.3%(12/35),RR率为62.9%(22/35),两者差别具有统计学意义(P<0.05)。此外,高度侵袭性患者和血清LDH高的患者,具有较低的CR率和RR率(P<0.05)。全组中位随访时间36个月(5个月~51个月),中位复发时间为7个月(3个月~34个月),中位生存时间11个月(3个月~51个月),1年和2年总生存率分别35.0%和11.4%。复发NHL和难治NHL没有显示生存差别(P=0.261)。主要不良反应是骨髓抑制,出现Ⅲ度~Ⅳ度的粒细胞和血小板减少的发生率分别为39.6%和26.4%。结论:GDP方案是中度侵袭性复发性或难治性非霍奇金淋巴瘤安全有效的化疗方案,对高度侵袭性NHL,该方案疗效值得进一步验证。LDH升高、高度侵袭性患者和难治者具有较差反应率。     

22例鼻咽非霍奇金淋巴瘤临床分析

目的:分析鼻咽非霍奇金淋巴瘤的发病率、治疗方法、疗效及预后.方法:对22例鼻咽非霍奇金淋巴瘤的临床资料进行回顾性分析.结果:误诊率为90.9%,治疗后CR 12例,PR 8例,PD 2例,有效率(CR PR)为90.9%.第1年死亡5例,其中高度恶性占62.5%、T细胞占40.0%、有B症状占50.0%、Ⅲ期4例、Ⅱ期1例;3年生存率为72.7%(16/22),5年生存率为63.6%(14/22).存活5年以上的病例均为无B症状,低、中度恶性及Ⅰ、Ⅱ期病例,B细胞占78.6%.化疗加局部放射治疗占85.7%.结论:鼻咽非霍奇金淋巴瘤占同期恶性淋巴瘤的4.68%,占结外淋巴瘤的16.67%,临床极易误诊,高度恶性、T细胞、有B症状者预后较差,分期越早预后越好,化疗加局部放射治疗预后较好.     

Malignant gliomas

Opinion statement Gliomas are a heterogeneous group of neoplasms that comprise the majority of tumors originating in the central nervous system (CNS). In adults, the most frequently encountered of these are high-grade or malignant neoplasms of astrocytic and oligodendrocytic lineage, ie, anaplastic astrocytoma (AA), glioblastoma multiforme (GBM), and anaplastic oligodendroglioma (AO), respectively. Tumors of mixed lineage are also seen, the most common of which is designated anaplastic oligoastrocytoma (AOA). Standard treatment for these tumors is typically surgery, followed by radiation then chemotherapy. Surgery is required for a definitive histopathologic diagnosis, which in turn will dictate subsequent therapy options. Moreover, aggressive tumor resection improves survival outcomes, and in many cases, the patient's neurologic function. We generally advocate the safest, maximal resection attainable for patients with these tumors as a way to improve prognosis. In almost all cases, surgery is followed by radiation therapy. Postsurgical irradiation is the most effective treatment currently available for improving survival. There is also mounting evidence to suggest that additional radiation, given in the form of brachytherapy or radiosurgery, at initial diagnosis as a “boost” to standard radiation or at tumor recurrence, may provide added improvement in survival outcome. Radiosurgery and brachytherapy are therapies often used to treat eligible patients at this institution. Adjuvant chemotherapy, conventionally given after radiation, may offer a modest survival benefit in some patients with GBM. Bischloroethylnitrosourea (BCNU) is the typical first-line agent used, but chemotherapy seems to be most beneficial in young patients, with little if any impact on survival for patients over 60 years old. At this institution, we often defer treatment with adjuvant chemotherapy for elderly patients with GBM due to lack of efficacy and the attendant risk with chemotherapy. For anaplastic astrocytomas, oligodendrogliomas, and oligoastrocytomas, a commonly accepted standard is adjuvant chemotherapy following irradiation with the three-drug regimen—procarbazine, CCNU, and vincristine (PCV). This is due to an earlier clinical trial that showed a survival advantage in patients treated with adjuvant PCV compared with patients that received BCNU. However, recent data suggest that treatment with either PCV or BCNU may be appropriate. Both regimens now appear to have equal efficacy for anaplastic gliomas in light of a more recent analysis done with larger numbers of patients. AOs are a unique case with respect to tumor chemosensitivity and patient survival. Molecular studies have identified a subpopulation of patients with AO whose tumors have lost chromosomes 1p and 19q. Patients with this molecular pattern have an exceptional responsiveness to PCV chemotherapy and have prolonged survival. Currently, trials are being conducted to confirm this finding and to determine the best treatment regimen for these patients, with particular regard to the timing of radiation and chemotherapy.     

Malignant pheochromocytoma

Malignant pheochromocytoma is a rare disease with a high mortality. Surgical resection is the only effective treatment if extensive metastatic disease is not present. However, differentiating between benign and malignant pheochromocytoma is impossible in the absence of locoregional invasion or distant metastasis. This diagnostic dilemma has several drawbacks, including later detection and treatment of recurrence than if malignancy is determined at the original operation. With emerging molecular markers of malignant disease, optimal extent and approach for surgical treatment and appropriate extent of follow up could be established based on specific tumor behavior and the need for additional systemic therapy.     

Malignant lymphoma

Based on the systematic improvements in treatment over recent decades, more than 70% of children and adolescents with non-Hodgkin lymphoma will survive at least 5 years with standard chemotherapy. This report highlights several advances in treatment for each histologic subtype of childhood non-Hodgkin lymphoma, focusing on published results of clinical trials from European and North American study groups.     

Malignant histiocytosis

The clinical features, therapy, and hospital course of ten consecutive patients with malignant histiocytosis (MH) are presented. The value of bone marrow aspiration for the diagnosis is discussed. The patient's performance status as described in this report by the organ dysfunction score may predict survival and response to chemotherapy. The literature on chemotherapy in this disease is reviewed. Combination chemotherapy may be the best approach to treatment, but there is little experience with single agents. There is a great need for better characterization of the malignant cell in this disorder.