吡柔比星与阿霉素治疗非霍奇金淋巴瘤的对比观察

吡柔比星于 1979年由日本梅泽宾夫等发现 ,是阿霉素 (ADM)的一个四氢吡喃衍生物 ,在 ADM的 4′位加上四氢吡喃基 ,由于化学结构和立体构型的改变 ,其抗肿瘤活性有所提高 ,优于或相当于 ADM,能有效地对抗耐 ADM的肿瘤 ,而心脏毒性、肠胃道反应和脱发等副作用明显降低 [1 ,2 ] 。自 1997年 1月 -2 0 0 0年 12月 ,我们分别采用吡柔比星(THP)与阿霉素为主的方案治疗老年非霍奇金淋巴瘤 (NHL) 2 7例 ,现将结果总结如下。1　资料与方法1.1　临床资料　均为我院住院患者 ,THP组 13例 ,男 8例 ,女 5例 ,年龄 6 0岁～ 75岁 (中位年龄 6 6岁 …     

含米托蒽醌方案治疗难治性非霍奇金淋巴瘤21例

采用米托蒽醌联合COP方案(CMOP)治疗难治性非霍奇金淋巴瘤(NHL)21例。结果完全缓解8例(38 1%) ,部分缓解6例(28 6 %) ,无效7例(33 3 %) ,总有效率66 7 %。     

吡喃阿霉素、表阿霉素及阿霉素为主联合化疗方案治疗非霍奇金淋巴瘤

目的：分别采用以吡喃阿霉素（THP）、表阿霉素（E－ADM）及阿霉素（ADM）为主的联合化疗方案治疗非霍奇金淋巴瘤,进行疗效及不良反应观察比较,方法采用CHOP方案治疗非霍奇多淋巴瘤68例,分为3组：吡喃阿霉素组23例,表阿霉素组22例,阿霉素组23例。3组治疗有效率（CR＋PR）分别为82．6％、86．4％、82．6％,3组之间无显著性差异。不良反应;肝功能异常,白细胞减少,血小板减少、贫血、恶心呕吐、,3组间比较无关差异。THP组心电图异常及脱发率低于E－ADM组和AMD组。结论吡喷阿霉素、表阿霉素及阿霉素非霍奇多淋巴瘤的疗效无差异,THP组心脏毒性,脱发率低于E－ADM组和ADM组。     

国产表阿霉素为主的联合方案治疗非霍奇金淋巴瘤临床观察

目的观察国产表阿霉素治疗非霍奇金淋巴瘤的疗效和毒副反应.方法治疗组37例采用环磷酰胺(CTX)750 mg/(m2·d),静脉滴注,d1;国产表阿素(EPI)70 mg/(m2·d),静脉推注,d1;长春新碱(VCR)1.4 mg/(m2·d),静脉推注,d1;强的松(Pred)60 mg/(m2·d),口服,d1～5.每21 d为一个疗程,每例患者至少接受4个周期的化疗.对照组以进口表阿霉素替代国产表阿霉素,治疗非霍奇淋巴瘤38例,进行随机对照,观察两组的疗效及毒副反应.结果国产表阿霉素为主的方案组,完全缓解率为43.2%(16/37),部分缓解率为37.8%(14/37),总有效率为81.1%.与进口表阿霉素为主的对照组比较,疗效相似,差异无显著性(P＞0.05).两组毒副反应主要为Ⅰ～Ⅱ度,治疗组与对照组白细胞减少发生率分别为59.5%和60.5%;恶心呕吐发生率分别为 67.6%和68.4%;心脏毒性轻微,发生率分别为 8.1%和7.9%;脱发发生率分别为94.6%和94.7%,对肝肾功能影响均较轻微.结论国产表阿霉素治疗非霍奇金淋巴瘤的疗效和毒副反应与进口表阿霉素相似,值得临床应用.     

米托蒽醌为主治疗复发及难治性淋巴瘤

颈部淋巴结针吸细胞学活检 (ｆｉｎｅｎｅｅｄｌｅａｓｐｉｒａｔｉｏｎｂｉｏｐｓｙ,ＦＮＡＢ)在临床上应用比较广泛。其方法简单 ,病人痛苦小 ,对疾病的诊断及治疗提供很大的帮助。选择我室 1995年 1月～ 2 0 0 0年 4月颈部淋巴结针吸细胞学检查 2 2 3例 ,进行回顾性分析。1　临床资料与方法1 1　临床资料　女性 117例 ,男性 10 6例 ,女∶男为 1∶1 1。发病年龄最小 4岁 ,最大 82岁 ,发病高峰为 2 0～6 0岁 ,占 6 6 %。左侧 152例 ,右侧 71例。1 2　方法　选择暴露较好、邻近无重要血管、神经的肿大淋巴结 ,常规碘酒、酒精局部消毒 ,左手…     

IEPP方案治疗难治性非霍奇金淋巴瘤疗效观察

初治的非霍奇金淋巴瘤 (ＮＨＬ)一般对化疗敏感 ,70 %以上患者可获长期生存 ,但仍有 15 %～ 30 %患者复发。这些治疗后达不到完全缓解或多次复发的病例 ,称之为难治疗ＮＨＬ。 1997年 2月～ 1999年 12月我们应用ＩＥＰＰ方案 (Ｉｆｏｓｆａｍｉｄｅ、Ｅｔｏｐｏ ｓｉｄｅ、Ｃｉ     

Mitoxantrone and Fludarabine in the Treatment of Patients with Non-Hodgkin's Lymphoma Failing Primary Therapy with a Doxorubicin-or Mitoxantrone-Containing Regimen

Patients with recurrent lymphoma of any grade were treated with mitoxantrone (12 mg/m² given intravenously (IV) over 15-30 minutes on day 1) followed by fludarabine at a dose of (25 mg/m 2 given IV over 30 minutes on days 1-3) every 28 days fludarabine at a dose of(25 mg/m² given IV over 30 minutes on days 1-3) every 28 days. All patients had failed one prior chemotherapy regimen that contained either doxorubicin or mitoxantrone, total dose not exceeding 350 mg/m² doxorubicin or 80 mg/m² mitoxantrone. mitoxantrone. Thirty one patients (22 with intermediate-or high-grade and 9 with low-grade NHL) were enrolled. Median age was 63 years (range: 21 to 87). The objective response rate for patients with intermediate/high-grade NHL was 55% (27% with CR) and 89% (56% with CR) for patients with low-grade NHL. Median time to disease progression was 5.1 months for patients with intermediate/high-grade NHL and 10.8 months for patients with low-grade NHL. Median time to death for patients with intermediate/high-grade disease was 11.4 months. Median time to death for patients with low-grade NHL was not calculable as only one death (due to respiratory failure) occurred in this group 6.5 months after study start. The regimen was well tolerated. Grade 3/4 neutropenia was reported in 80% (24 of 30) of patients and Grade 3/4 thrombocytopenia in 19% (6 of 31) of patients. Nine hospitalizations for adverse events (primarily fever and neutropenia) occurred among eight patients, all with intermediate/high-grade NHL, during a total of 118 cycles of therapy. Further studies of this combination regimen in patients with intermediate/high-grade NHL and studies combined with monoclonal antibodies in low-grade NHL are warranted.     

Cemp, A Mitoxantrone Containing Combination, in the Treatment of Intermediate and High Grade Non-Hodgkin's Lymphoma: an Effective and Non Toxic Therapeutic Alternative for Adult and Elderly Patients: On behalf of Non-Hodgkin's Lymphoma Co-operative Study Group (NHLCSG)

Here we report the results of a randomised multicenter phase III clinical trial which assesses the therapeutic efficacy and tolerability of a chemotherapy protocol CEMP (cyclophosphamide, etoposide, mitoxantrone and prednisone) in adult and elderly patients with advanced intermediate and high-grade NHL.

Between October 1991 and October 1995, 139 patients, aged 55 to 79 years, with diffuse intermediate and high-grade lymphoma, were enrolled. A considerable percentage of patients had clinically aggressive disease: 32.4% had systemic symptoms, 79% had stage III or IV disease, 33.8% had bone marrow involvement, 46% had splenic involvement and 42.5% had increased values of serum lactate dehydrogenate. Complete remission was achieved in 70 of the 139 patients (51.9%) and PR in 12 (16.6%) with an overall response of 68.5%. The overall response survival rate at 6 years was 39%, whereas DFS rate was 48.7% and PFS rate was 28.5%. At four years 49% of the patients were still in CR. Dividing the patients in two groups, under and over 65 years of age, we obtained the same results as far as overall response is concerned. No toxic deaths occured, neither cardiac, renal nor liver complications happened. CEMP regimen is an effective and safe protocol with good results in elderly people, well comparable to those achieved in younger ones.     

Clinical Observation of FMD Regimen:Fludarabine,Mitoxantrone, Dexamethasone, in Treatment of Non-Hodgkin''s Lymphoma

Objective  To evaluate the clinical effectivity and toxicity of the regimen FMD (fludarabine, mitoxantrone, dexamethasone) in patients with non-Hodgkin’s lymphoma. Methods  Thirty-two patients, twenty-four of whom had indolent B-cell lymphoma, 6 peripheral T-cell lymphoma, two diffuse large B-cell lymphoma, received FMD. Treatment comprised: fludarabine 25∼30 mg/m² days 1∼3, mitoxantrone 8∼10 mg/m² day 1, and dexamethasone 20∼30 mg/m² days 1∼5. At the same time, patients received prophylaxis against conditional infection with trimethoprim-sulfamethoxazole, fluconazole, acyclovir and immunoglobulin. Results  Of the thirty-two patients treated, the complete response (CR) rate, partial response (PR) rate and overall response (OR) rate were 56.3%, 21.9% and 78.2% respectively. The CR and OR rate of 24 patients with indolent B-cell lymphoma were 66.7% and 88.3% respectively. Two of six patients with peripheral T-cell lymphoma were of complete response type and one was of partial response type. One of two patients with diffuse large B-cell lymphoma was partial response. The dominating toxicity was myelotoxicity and immunotoxicity. There was no treatment associated death in all patients treated with FMD. Grade 3∼4 neutropenia occurred in 43.8% patients, 12.5% patients had infections and 9.3% developed grade 3∼4 thrombocytopenia. At a median follow-up of 24 (5∼54) months, the 2-year overall-survival rate and progression-free survival rate were (87.5 ± 1.4)% and (83.3 ± 1.6)% respectively. The 2-year OS and PFS rates of the indolent group were (93.75 ± 6.25)% and (87.5 ± 8.54)%. Conclusion  FMD regimen was highly effective with low toxicity in the treatment of non-Hodgkin’s lymphoma, especially in indolent B-cell lymphoma. It also helps to improve the prognosis even in some aggressive lymphoma, such as peripheral T cell lymphoma.     

IEP方案治疗37例复发性、难治性非霍奇金淋巴瘤

[目的]研究复发性，难治性中高度恶性非零奇金淋巴瘤的解救治疗。[方法]37例复发性，难治性中高度恶性非霍奇金淋巴瘤病人用IEP方案治疗；异环磷酰胺（IFO）2g静脉点滴，第1-4天（同时使用美斯纳）；足叶乙甙（Vp-16)100mg，静脉点滴，第1-4天；顺铂30mg/m^2，静脉点滴，第1-3天；21-28天为1周期，连用2周期评定疗效。[结果]总缓解率为81.1%(30/37)。完全缓解率（CR）为35.1%(13/37)，部分缓解率为45.9%(17/37)。主要不良反应为骨髓抑制和脱发，白细胞减少发生率为83.8%，其中Ⅲ-Ⅳ度发生率占43.2%。血红蛋白及血小板减少发生率分别为37.8%和43.2%。脱发发生率为91.2%，其它不良反应湛和见。[结论]IEP方案可作为复发性，难治性中高度恶性淋巴瘤的解救治疗。     

MINE方案治疗复发难治性非霍奇金淋巴瘤23例

 目的 观察MINE（MIT、VP16、IFO）方案治疗复发及难治性非霍奇金淋巴瘤近期疗效及毒副反应。方法 23例经CHOP方案治疗失败的NHL患者接受MINE方案化疗至少2个周期，MIT6～8mg／m^2／d，静滴，d1；IFO 2．0静滴，d1-3，配合美司那400mg／次，0h、4h、8h静推3次；VP1680mg／m²／d，静滴，d1～3。疗效及毒性判定按照WHO标准。结果 完全缓解（CR）5例，部分缓解（PR）10例，稳定（SD）3例，进展（PD）5例，总有效率（CR＋PR）65．2％，毒副反应主要为骨髓抑制，白细胞减少率73．9％，以Ⅰ～Ⅱ度为主。经G-CSF支持后恢复正常，无与毒性相关的死亡发生。结论 MINE方案治疗难治性NHL有较高疗效，并较为安全，患者可耐受。     

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。     

米托蒽醌、氟尿嘧啶与亚叶酸钙联合治疗有转移的乳腺癌41例

目的：观察米托蒽醌（Ｍｉｔｏｘａｎｔｒｏｎｅ，ＭＩＴ）、氟尿嘧啶（Ｆｌｕｏｒｏｕｒａｃｉｌ，５－ＦＵ），亚叶酸钙（Ｌｅｕｃｏｖｏｒｉｎ，ＣＦ?治疗有转移的乳腺癌的疗效。方法：采用ＭＴＴ、５－ＦＵ与ＣＦ联合治疗有转移的乳腺癌４１例，２６例初治，１５例复治，雌激素受体（ＥＲ）阳性１９例，采用ＭＩＴ１２ｍｇ／ｍ＾２静脉推注，第１天；５－ＦＵ３２０ｍｇ／ｍ＾２静脉滴注，ｄＩ－５，ＣＦ５０ｍｇ／ｍ＾２静脉推注，与５－ＦＵ一起开始用，间隔１２ｈ一次，连续５天，每３周重复。结果：完全缓解（ＣＲ）１１例，部分缓解（ＰＲ）１９例，总有效率７３．２％，中位缓解期１７月，中位生存期２３月，本方案主要毒性为骨髓抑制，白细胞下降占８５．４％，其中Ⅲ、Ⅳ度为１９．５％，口腔炎发生率９．８％，局部静脉炎发生率１２．２％。结论：该方案治疗转移     

国产鬼臼乙叉甙软胶囊治疗非霍奇金淋巴瘤34例近期疗效观察

观察国产鬼臼乙叉甙软胶囊治疗NHL的疗效及副作用。方法：选取可评价疗效的患者34例，分单药治疗和联合用药（CHEP方案）两组，各17例。结果：单药治疗组有效率（CR＋PR）为82．4％，联合用药组为94．l％；两组毒副反应较轻，均可耐受。结论：国产鬼臼乙叉甙软胶囊治疗NHL有较好疗效，且毒副反就较轻。     

MACOP-B Chemotherapy for the Treatment of Aggressive Non Hodgkin's Lymphoma

From September 1986 to September 1990, 26 patients with aggressive non Hodgkin's lymphoma were treated with the MACOP-B regimen (21 patients as first treatment, 5 relapsed or refractory to an anthracycline derivative containing regimen). 17 patients (65%) achieved a complete response, 4 (15%) had a partial response and 5 (20%) were treatment failures. After complementary radiotherapy 2 patients with PR achieved CR achieving a subsequent CR rate of 73%. CR rate was adversely affected by stage of the disease (IV = 40% vs I + II + III = 80%) and B symptoms (B = 58% vs A = 85%). Relapses occurred in 7 patients (7/19). For complete responders, the Disease-Free-Survival was 55% Over a median follow-up of 20 months, the overall probability of survival was 51%.

Toxicity was moderate with no treatment-related toxic deaths but 3 Pneumocystis carinii infections occurring before the introduction of systematic prophylaxis with sulfamethoxazol-trimethoprim. This study confirms the efficiency of the MACOP-B regimen for the treatment of patients with standard aggressive NHL. However, there is a subset of patients with poor prognosis factors (like stage IV disease) who might benefit from other therapeutic modalities like dose-intensification based regimens with hematopoietic growth factors support or intensive consolidation with autologous bone marrow transplantation.     

CVDLP与CHOP方案治疗Ⅲ/Ⅳ期淋巴母细胞性淋巴瘤诱导缓解期疗效比较

目的：探讨早期强烈诱导缓解方案提高晚期淋巴母细胞性淋巴瘤的完全缓解（complete remission,CR)率。方法：11例Ⅲ/Ⅳ期初治淋巴母细胞性淋巴瘤,诱导缓解期接受CVDLP方案化疗：环磷酰胺1000mg/m^2d1,长春新碱1．5mg/m^2d1、d8、d15、d21,阿霉素40mg/md1、d2、d21,门冬酰胺酶10000U/m^2d15-24,强的松60mg/m^2d1-28,第15天逐步减量。氨甲喋呤加阿糖胞苷鞘内注射每周一次,共4次,28-33每天 评价疗效。同时回顾性比较9例初治Ⅲ/Ⅳ期淋巴母细胞性淋巴瘤,采用标准CHOP方案治疗两疗程后的疗效（第35天）。结果：CVDLP方案组10例初治病人获得完全缓解,1例病人获得部分缓解,完全缓解率达90．9％;10例病人出现Ⅳ级血液毒性,1例病人出血Ⅲ级血液毒性（WHO标准）。CHOP组3例完全缓解,5例部分缓解,1例微效,完全缓解率达33％;3例病人出现Ⅲ级血液毒性,6例病人出现Ⅱ级血液毒性。结论：对于晚期淋巴细胞瘤,诱导缓解采用CVDLP方案获得的早期完全缓解率明显高于CHOP方案,血液毒性也比CHOP大小,但加强支持疗法,此诱导缓解方案安全可行。