硼替佐米联合阿霉素及地塞米松治疗复发难治性套细胞淋巴瘤15例

探讨硼替佐米联合阿霉素、地塞米松组成的PAD（bortezomib、doxorubicin and dexamethasone）方案治疗复发、难治性套细胞淋巴瘤（mantle cell lymphoma，MCL）的疗效及安全性。方法：用PAD方案治疗15例复发、难治性MCL，分析其疗效及影响因素，同时观察不良反应。PAD方案治疗4～6个疗程：硼替佐米（1.3 mg/m2，d1、4、8、11，快速静脉注射）、阿霉素（10 mg/d，d4～6，静脉注射）和地塞米松（40 mg/d，d4～6，口服，每21天为1个疗程）。结果：80%（12/15）患者达PR及PR以上疗效，其中CR 26.7%（4/15，均经PET-CT证实），PR 53.3%（8/15）。无病进展时间（PFS）13.5（3.5～25.1）个月，中位生存时间（OS）35.6（6.3～42.8）个月。PAD方案主要不良反应表现为：Ⅲ～Ⅳ级血小板减少（33.3%），Ⅱ级乏力（26.7%），Ⅱ级周围神经炎（13.3%），带状疱疹病毒感染（20.0%）。结论：PAD方案可有效提高难治性MCL患者疗效，不良反应多轻微可控。

Bortezomib Combined with Doxorubicin and Dexamethasone for Patients with Refractory Senile Mantle Cell Lymphoma

To explore the efficacy and safety of the bortezomib combined with doxorubicin and dexamethasone ( PAD ) regimen in the treatment of refractory/advanced senile mantle cell lymphoma. Methods: The activity and safety of the PAD regimen were investigated in 5 senile patients with refractory/ advanced mantle cell lymphoma. Four to six 21-day cycles of PAD regimen consisted of bortezomib ( 1.3 mg/m2, days 1, 4, 8, and 11 ), doxorubicin ( 10 mg, day 1 ), dexamethasone ( 40 mg, days 1-4 ). Results: Four/five patients achieved ≥PR response, with 2 patients achieving a complete response (also negative for disease activity by positron emission tomography scanning ). Median progression free and overall survival was 12.3 ( 3.5-23.8 ) and 31.8 ( 6.3-41.7 ) months, respectively. The toxic effects of the PAD regimen included grade II thrombocytopenia (2/5), grade IV thrombocytopenia (1/5), grade II neutropenia ( 2/5 ), grade II fatigue ( 1/5 ), grade II peripheral neuropathy ( 1/5 ), herpes zoster ( 1/5 ). Conclusions: Bortezomib combined with doxorubicin and dexamethasone might be a promising therapy, with efficacy and manageable adverse events in senile patients with refractory/advanced mantle cell lymphoma.