氟达拉滨联合表柔比星治疗复发难治性惰性非霍奇金淋巴瘤

目的:探讨FE（氟达拉滨联合表柔比星）方案作为二线解救方案治疗复发难治性的惰性淋巴瘤（Non-Hodgkin's Lymphoma ，NHL ）的有效性和安全性。方法:经组织病理学证实的复发难治性惰性NHL 79例，按信封法随机分为FE方案组与FMD方案组。39例采用FE方案化疗（氟达拉滨25mg/m2/d ，d1～d3；表柔比星（EPI）60mg/m2/d ，d1，28天为1 周期），40例采用FMD方案化疗（氟达拉滨25mg/m2/d ，d1～d3；米托蒽醌10mg/m2/d ，d1；地塞米松20mg/d ，d1～d5，28d 为1 周期）。 所有患者均至少完成2 个周期化疗。结果:FE组有效率（CR+PR）64.1% ，临床受益率（CR+PR+SD ）79.5% ，中位无进展生存期21个月，2 年总生存率71.8% ；FMD组有效率（CR+PR）57.5% ，临床受益率（CR+PR+SD ）75% ，中位无进展生存期20个月，2 年总生存率60% 。FE组的疗效略优于FMD组，但两组间差异无统计学意义（P>0.05）。 中位无进展生存期和2 年总生存率两组间亦无统计学意义（P>0.05）。 两组不良反应均以中性粒细胞减少和感染最为常见，其中Ⅲ～Ⅳ度骨髓抑制FE组15.4%（6/39），FMD组29%（15/40），经升血治疗处理恢复；肺感染FE组5.1%（2/39），FMD组22.5%（9/40）。 FE组Ⅲ～Ⅳ度中性粒细胞缺乏和肺感染发生率均较FMD组轻，两组不良反应发生率间有统计学差异（P<0.05）。 结论:FE方案治疗复发难治性惰性NHL 的疗效肯定，骨髓毒性和肺感染发生率明显低于FMD组，是复发难治性惰性NHL 患者安全有效的解救方案，值得进一步推广应用。 

Fludarabine Combined with Epirubicin Second-line Chemotherapy for Patients with Relapsed or Refractory Indolent Non-Hodgkin's Lymphoma

Objective:To evaluate the efficacy and safety of a Fludarabine and Epirubicin (FE) regimen in the treatment of refractory or relapsed indolent non-Hodgkin ’s lymphoma (NHL). Methods:A total of79patients with histopathologically verified relapsed or refractory indolent NHL were randomly assigned to be treated with FE regimen (Fludarabine 25mg/m2×3, d1～d3; Epirubicin 60mg/m2, d1, one cycle for 28days) or FMD regimen (Fludarabine 25mg/m2× 3, d1～d3; Noventrone 10mg/m2, d1; Dexamethasone 20mg/d, d1～d5). All patients received treatment for about 2 cycles.Results: The response rate, clinical benefit response, median progression-free survival and 2-year survival rates in the two groups were64.1% vs. 57.5%,79.5% vs.75%,21months vs. 20months, and 71.8% vs.60%, respectively. There was no statistically significant difference in the overall response rate or the 2-year overall survival rate between the 2 groups ( P>0.05). The main side ef -fects were leucopenia and infection. The incidence of Ⅲ～Ⅳmyelosuppression was15.4% vs. 29% in the FE and FMD groups; symptoms of infection occurred in 5.1% vs.22.5% of the FE and FMD groups, respectively. The incidence ofⅢ～Ⅳleucopenia and pneumonia in the FE group was slightly lower than in the FMD group, and the difference had statistical significance ( P<0.05). Conclusion:The efficacy of the FE regimen was as good as that of the FMD regimen, but the FE group had a lower incidence of Ⅲ～Ⅳleucopenia and pneumonia than the FMD group. Thus the FE regimen is a promis -ing and effective second-line salvage regimen for the treatment of relapsed or refractory indolent non-Hodgkin ’s lympho-ma, worthy of wider use.