改良Hyper—CVAD／MA方案治疗侵袭性淋巴瘤42例

目的评估改良的Hyper-CVAD／MA强化方案治疗侵袭性淋巴瘤患者的有效性和安全性。方法回顾性分析2006年6月至2012年7月收治的42例用改良Hyper-CVAD／MA方案治疗的初治或复治的侵袭性淋巴瘤患者的有效性和安全性。结果19例（45．3％）患者达完全缓解（CR）,13例（31．0％）达部分缓解（PR）,有效率为76．2％（32／42）。1年无病生存（DFS）率和总体生存（OS）率分别为79．2％和83．7％,3年DFS率和OS率分别为65．3％和64．2％。CR率与有无B症状、结外受累、中枢神经系统受累、AnnArbor分期、既往治疗有相关性。主要不良反应包括造血功能受抑、感染、黏膜炎、肝脏、肾脏以及神经系统毒性等。结论改良Hyper—CVAD／MA方案治疗侵袭性淋巴瘤近期疗效满意,治疗相关不良反应可以控制。     

Hyper-CVAD/MA方案治疗侵袭性非霍奇金淋巴瘤20例

 目的　评价Hyper-CVAD／MA方案治疗侵袭性非霍奇金淋巴瘤（NHL）的安全性和有效性。方法　回顾性分析用此方案治疗的20例侵袭性NHL的疗效及安全性。结果　20例NHL患者的总有效率（RR）达60 %,完全缓解（CR）率达33.3 %,巩固化疗的CR率达23 %。最常见的不良反应是骨髓抑制,尤其是用MA方案化疗时,75 %患者需要输注血小板,其他如消化道反应、肝肾毒性轻微,死亡率5 %。结论　Hyper-CVAD／MA方案是治疗侵袭性NHL较有前景的方案,但需要临床大样本、多中心观察。     

培美曲塞为主的化疗方案治疗中老年非霍奇金淋巴瘤回顾性分析CSCD

目的回顾性分析培美曲塞为主的化疗方案治疗中老年非霍奇金瘤患者的安全性及有效性。方法回顾性收集2016年11月至2018年10月中国医学科学院肿瘤医院收治的以培美曲塞为主的化疗方案治疗的非霍奇金淋巴瘤患者临床资料,并对相关文献进行系统性综述。结果共纳入10例非霍奇金淋巴瘤患者,7例为弥漫大B细胞淋巴瘤,2例为血管免疫母T细胞淋巴瘤,1例为结外NK/T细胞淋巴瘤。肿瘤复发或一线治疗进展后接受培美曲塞为主的化疗方案,弥漫大B细胞淋巴瘤有4例达到部分缓解,3例疾病进展,出现的不良反应主要为Ⅰ~Ⅱ度骨髓抑制及胃肠道反应。结论培美曲塞为主的化疗方案治疗弥漫大B细胞淋巴瘤患者,尤其是原发性中枢神经系统淋巴瘤,可能有一定的有效性,且安全性可控。     

白血病期母细胞性浆细胞样树突细胞肿瘤2例并文献复习

目的探讨白血病期母细胞性浆细胞样树突细胞肿瘤(BPDCN)患者的治疗及预后。方法回顾性分析2016年5月至2017年2月河北大学附属医院收治的2例白血病期BPDCN患者临床资料、诊断及治疗经过, 并复习相关文献。结果 2例患者均有皮肤和骨髓浸润, 其中1例为70岁老年人, 1例为14岁青少年。均应用Hyper CVAD+MA方案治疗。老年患者在持续治疗过程中出现髓内复发, 再诱导阶段死于严重感染, 生存期14个月。青少年患者间断治疗, 中断治疗期间出现原发病复发, 再次采用Hyper CVAD+MA方案诱导后达完全缓解, 并进行CD123嵌合抗原受体T细胞(CAR-T)巩固治疗, 生存期44个月。结论白血病期BPDCN恶性度高、预后差, Hyper CVAD方案诱导缓解率高, CD123 CAR-T治疗可能延长生存期。     

侵袭性非霍奇金淋巴瘤治疗进展

研究表明持续给药方式和新型靶向药物有望改善侵袭性B细胞淋巴瘤患者的预后,加大化疗药物剂量未显示疗效提高.侵袭性T细胞淋巴瘤患者的预后近些年有所改善,归因于自然杀伤细胞/T细胞淋巴瘤化疗方案的改进.多发遗传学异常是侵袭性T细胞淋巴瘤不良预后的内因,非清髓性异基因造血干细胞移植和新型靶向药物提示增加治疗疗效.现代放疗技术也是提高侵袭性非霍奇金淋巴瘤疗效的重要手段.     

Hyper-CVAD/MA方案治疗15例高度侵袭性非霍奇金淋巴瘤临床观察

目的：观察Hyper-CVAD/MA方案治疗高度侵袭性非霍奇金淋巴瘤的疗效和不良反应。方法：对15例高度侵袭性非霍奇金淋巴瘤患者采用Hyper-CVAD/MA方案治疗：Hyper-CVAD方案：环磷酰胺300 mg/m^2静脉注射,每日两次,d1-d3;长春新碱1.4mg/m^2,静脉注射,d4、d11;吡柔比星50mg/m^2,静脉输注,d4;地塞米松40mg,静脉滴注d1-d4、d11-d14。MA方案：氨甲喋呤1.0g/m^2,持续静脉滴注24h,d1;阿糖胞苷1.0g/m^2,静脉滴注,每12小时1次,d2-3。结果：15例患者中,总有效率为73.3%,其中CR 7例（46.7%）,PR4例（26.6%）,随访1年无进展生存率（PFS）为66.7%,1年总生存率（OS）为80.0%。不良反应主要为化疗相关的骨髓抑制。结论：Hyper-CVAD/MA方案治疗高度侵袭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。     

Hyper-CVAD/MA方案治疗15例高度侵袭性非霍奇金淋巴瘤临床观察

目的:观察Hyper-CVAD/MA方案治疗高度侵袭性非霍奇金淋巴瘤的疗效和不良反应。方法:对15例高度侵袭性非霍奇金淋巴瘤患者采用Hyper-CVAD/MA方案治疗:Hyper-CVAD方案:环磷酰胺300 mg/m2静脉注射,每日两次,d1-d3;长春新碱1.4mg/m2,静脉注射,d4、d11;吡柔比星50mg/m2,静脉输注,d4;地塞米松40mg,静脉滴注d1-d4、d11-d14。MA方案:氨甲喋呤1.0g/m2,持续静脉滴注24h,d1;阿糖胞苷1.0g/m2,静脉滴注,每12小时1次,d2-3。结果:15例患者中,总有效率为73.3%,其中CR 7例(46.7%),PR4例(26.6%),随访1年无进展生存率(PFS)为66.7%,1年总生存率(OS)为80.0%。不良反应主要为化疗相关的骨髓抑制。结论:Hyper-CVAD/MA方案治疗高度侵袭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。     

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.     

吉西他滨组成方案挽救治疗非霍奇金淋巴瘤的疗效与安全性分析

目的:探讨GDP和GemOx方案治疗复发难治性非霍奇金淋巴瘤的早期疗效及安全性。方法:选取本院2016年1月至2017年8月收治的复发难治性弥漫大B细胞淋巴瘤及复发难治性NK/T细胞淋巴瘤患者共52例,其中25例接受 GDP方案化疗,27例接受GemOx方案化疗。观察两组患者早期临床疗效和毒副反应。结果:GDP方案组患者总有效率52.00%,GemOx方案组患者总有效率59.26%。两种方案的主要毒副反应均为轻度的消化道反应、血液学毒性及转氨酶升高。结论:以吉西他滨为基础的联合化疗方案可作为复发难治性非霍奇金淋巴瘤的治疗选择。     

GemOx±R方案治疗复发或难治的侵袭性非霍奇金淋巴瘤

目的：观察GemOx±R方案治疗复发或难治的侵袭性非霍奇金淋巴瘤（NHL ）的近期疗效和不良反应。方法：经组织学证实的复发或难治的侵袭性29例NHL 患者给予GemOx±R方案：吉西他滨（gemcitabine ）1 000mg/m2,静脉注射,d1、d8;奥沙利铂（oxaliplatin）130mg/m2,静脉注射d1;加/不加利妥昔单抗（rituximab ）375mg/m2,静脉注射,d0。21~28d 为一个周期。每个患者均完成≥2 周期的化疗。结果：29例患者中,总有效率为65.5% ,11例完全缓解（CR）,8 例部分缓解（PR）;B 细胞和T 细胞淋巴瘤患者的有效率分别为68.4% 和60.0% ,差异无统计学意义（P>0.05）;但在B 细胞淋巴瘤中,加用美罗华与否的有效率分别为80.0% 和55.6% ,差异有统计学意义（P=0.043）。 不良反应主要表现为骨髓抑制和胃肠道反应,表现为粒细胞、血小板减少及恶心、呕吐等。结论：GemOx±R方案高效低毒,是针对复发或难治性的侵袭性非霍奇金淋巴瘤安全有效的解救方案。     

改良Hyper-CVAD/MA方案治疗25例淋巴系统恶性肿瘤的临床分析

  目的  评价改良Hyper-CVAD/MA方案治疗国内成人急性淋巴细胞白血病（ALL）和非霍奇金淋巴瘤（NHL）的疗效及安全性。  方法  对2006年5月至2011年6月接受改良Hyper-CVAD/MA方案治疗的17例成人ALL和8例NHL共25例的疗效和不良反应进行回顾性分析。  结果  25例共完成40个周期A方案与29个周期B方案化疗,1年总体生存（OS）为（61.3±10.2）%。17例ALL 1年OS为（62.6±12.2）%。接受2~4个周期该方案化疗的患者与仅接受1个周期该方案化疗的患者相比,中位OS时间延长（P=0.046）。8例NHL 1年OS为（60.0±18.2）%。接受4~7个周期该方案化疗的患者与接受2个周期该方案化疗的患者相比,中位OS时间延长（P=0.021）。主要不良反应是骨髓抑制及感染,不良反应可控制,B方案的延长并未减低不良反应。  结论  改良Hyper-CVAD/MA方案用于淋巴系统恶性肿瘤的治疗,疗效满意,治疗相关不良反应可控制,值得推广。      

改良Hyper-CVAD方案治疗恶性淋巴瘤患者的安全性和疗效评价

背景与目的：常规化疗方案治疗某些病理类型的侵袭性淋巴瘤疗效不佳。本研究评价改良Hyper-CVAD方案治疗侵袭性淋巴瘤患者的安全性和疗效。方法：对2004年6月至2008年6月在中国医学科学院肿瘤医院接受改良Hyper-CVAD方案化疗的31例非霍奇金淋巴瘤患者的不良反应和疗效等资料进行分析和评价。结果：31例患者共完成91个周期A方案,41个周期B方案化疗。中位化疗周期为4周期（1～7周期）。患者主要的不良反应是骨髓抑制,接受A方案和B方案期间Ⅲ～Ⅳ度粒细胞减少、血小板减少和粒细胞减少性发热的发生率分别为49．5％和80．5％、3．3％和82．9％以及12．1％和46．3％。全组无治疗相关死亡。共26例患者可评价疗效,总的客观缓解率达80．8％,12例达到完全缓解（46．2％）。结论：改良Hyper-CVAD方案是治疗侵袭性和高度侵袭性非霍奇金淋巴瘤患者较有前景的方案。     

DNCE方案治疗复发或难治的侵袭性非霍奇金淋巴瘤

目的 探讨DNCE方案作为二线解救方案治疗复发或难治的侵袭性非霍奇金淋巴瘤(NHL)的有效性和安全性.方法 经病理学或组织学证实的、且一线CHOP方案治疗后进展的侵袭性恶性NHL患者69例,按信封法随机分为DNCE方案组与DICE方案组.其中DICE组37例,采用地塞米松(DXM)20 mg,静脉滴注,d1～d4;异环磷酰胺(IFO)1 S/m2,静脉滴注,d1～d4;Mesna解救400 mg,静脉滴注q8h,d1～d4;顺铂(DDP)25 mg/m2,静脉滴注,d1～d4;依托泊苷(Vp-16)100 ms/m2,静脉滴注,d1～d4.21～28d为1个周期.DNCE组32例,采用DXM、DDP、Vp-16的剂量与DICE方案相同;NVB 25 ms/m2,静脉滴注,d1和d5.21～28d为1个周期.所有患者均完成≥2个周期的化疗.结果 DNCE组中,完全缓解(CR)6例,部分缓解(PR)12例,有效率为56.3%(18/32);DICE组中,CR 4例,PR 13例,有效率为45.9%(17/37).DNCE组的疗效优于DICE组,但两组间差异无统计学意义(P>0.05).DICE组的1、3、5年生存率分别为86.5%、58.3%和42.9%,DNCE组分别为87.5%、63.2%和38.5%,两组间差异无统计学意义(P>0.05).两组主要的不良反应为骨髓抑制和消化道反应,表现为粒细胞、血小板减少及恶心、呕吐等.DNCE组的骨髓毒性轻于DICE组,差异有统计学意义(P<0.05).结论 DNCE方案治疗侵袭性NHL的疗效肯定,骨髓毒性较DICE方案为轻,是侵袭性NHL患者安全有效的解救治疗方案.     

Feasibility of High-Dose Chemotherapy without Stem Cell Support as a First-Line Treatment for Non-Hodgkin's Aggressive Lymphoma: A Pilot Study

A regimen which incorporates cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) is the standard treatment for patients with non-Hodgkin's lymphoma (NHL), but it has not been effective in patients with aggressive NHL who are at high risk. The aim of the present trial was to investigate the feasibility of high-dose chemotherapy (HDC) without stem cell support as a first-line treatment. The primary endpoint was a complete remission rate. The second endpoint was survival. Fourteen patients with aggressive NHL entered the study and were treated according to the K93 protocol (3 cycles of CHOP, high-dose etoposide and ifosfamide, and high-dose methotrexate) Eleven patients (79%) achieved complete remission (CR) and two (14%) achieved partial remission (PR). Overall survival (OS) after five years was 79%. The actuarial five year disease free survival (DFS) for the eleven cases of CR was 75%. During chemotherapy, grade IV hematologic toxicity was observed in all patients and grade IV non-hematologic toxicity in only one patient, who experienced oral ulcers. Peripheral blood stem cell (PBSC) apheresis was performed in eight cases. One harvesting was enough to provide an adequate number of CD34+ cells for the subsequent PBSC transplantation (PBSCT).

In conclusion our study confirmed the efficacy of the K93 protocol in obtaining a good response (CR + PR) rate and a very good DFS rate in most cases of aggressive NHL, with acceptable toxicity. This regimen may improve the outcome in cases of aggressive NHL without stem cell support. It seems worthwhile to conduct a randomized controlled study comparing the K93 protocol with the standard CHOP regimen.     

Feasibility of high-dose chemotherapy without stem cell support as a first-line treatment for non-Hodgkin's aggressive lymphoma: a pilot study

A regimen which incorporates cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) is the standard treatment for patients with non-Hodgkin's lymphoma (NHL), but it has not been effective in patients with aggressive NHL who are at high risk. The aim of the present trial was to investigate the feasibility of high-dose chemotherapy (HDC) without stem cell support as a first-line treatment. The primary endpoint was a complete remission rate. The second endpoint was survival. Fourteen patients with aggressive NHL entered the study and were treated according to the K93 protocol (3 cycles of CHOP, high-dose etoposide and ifosfamide, and high-dose methotrexate) Eleven patients (79%) achieved complete remission (CR) and two (14%) achieved partial remission (PR). Overall survival (OS) after five years was 79%. The actuarial five year disease free survival (DFS) for the eleven cases of CR was 75%. During chemotherapy, grade IV hematologic toxicity was observed in all patients and grade IV non-hematologic toxicity in only one patient, who experienced oral ulcers. Peripheral blood stem cell (PBSC) apheresis was performed in eight cases. One harvesting was enough to provide an adequate number of CD34+ cells for the subsequent PBSC transplantation (PBSCT). In conclusion our study confirmed the efficacy of the K93 protocol in obtaining a good response (CR + PR) rate and a very good DFS rate in most cases of aggressive NHL, with acceptable toxicity. This regimen may improve the outcome in cases of aggressive NHL without stem cell support. It seems worthwhile to conduct a randomized controlled study comparing the K93 protocol with the standard CHOP regimen.     

Uracil-DNA glycosylase (UNG) rs246079 G/A polymorphism is associated with decreased risk of esophageal cancer in a Chinese population

The prognosis of relapsed or refractory aggressive non-Hodgkin’s lymphoma (NHL) after front-line therapy remains poor. The development of more effective and less toxic salvage regimens remains a major challenge. Survivin is a member of the family of inhibitors of apoptosis, and survivin was associated with short survival and bad prognosis. This study was to evaluate the efficacy of GDP regimen (gemcitabine, dexamethasone and cisplatin) on relapsed or refractory aggressive NHL and various prognostic factors with special emphasis on survivin and observe the . Forty-six patients with relapsed and refractory NHL, intermediate or high-grade NHL (Revised European American Lymphoma Classification), who at least one regimen were enrolled into this study, which was carried out at Department, , Tanta University from July 2012 to July 2014. The patients were treated with GDP regimen (gemcitabine 1,000 mg/m² on days one and eight, dexamethasone 40 mg on days 1–3, and cisplatin 25 mg/m² on days 1–3) every 3 weeks. The efficacy and adverse events were evaluated according to the WHO criteria. All patients were assessed for efficacy and toxicity. The overall response rate was 58.7 %. Fourteen patients showed a complete response, thirteen partial responses, twelve stable diseases, and seven progressive disease. The 24-month overall survival was 50.8 %. Survivin is associated with low overall response and shorter overall survival. Grade 3 anemia was observed in four patients, grade 3 leucopenia in six patients, grade 3 neutropenia in six patients, and grade 3 thrombocytopenia in four patients. Non-hematologic toxicity included grade 3 infection in four patients. The present schedule of GDP showed modest efficacy and mild toxicity in patients with relapsed or refractory aggressive NHL.