EPOCH方案联合培门冬酶治疗复发难治性T细胞非霍奇金淋巴瘤临床研究

目的 观察EPOCH方案联合培门冬酶治疗复发难治性T细胞非霍奇金淋巴瘤(T-NHL)的疗效和不良反应.方法 收集北京军区总医院血液科2010年1月至2014年1月收治的15例经病理确诊的T-NHL患者,均为复发难治性,采用培门冬酶联合EPOCH方案化疗,具体方案为:依托白苷50 mg/m2,表柔比星12 mg/m2,长春新碱0.4 mg/m2,第1天至第4天;环磷酰胺750 mg/m2,第5天;培门冬酶每天2500U/m2,第6天;泼尼松60 mg/m2,第1天至第6天,21 d为1个周期,共进行2～8个周期.结果 15例中完全缓解4例(26.7％),部分缓解6例(40.0％),总有效率66.7％,全组患者中位生存期20个月(5～30个月),2年总生存率为46.6％.主要不良反应为肝损伤、骨髓抑制及凝血功能异常.结论 EPOCH方案联合培门冬酶治疗复发难治T-NHL疗效较好,不良反应较少,患者可耐受,值得临床进一步研究.

Clinical study on pegaspargase combined with EPOCH regimen in the treatment of relapse and refractory non-Hodgkin's T-cell lymphoma

Objective To observe the effect and toxicity of pegaspargase combined with EPOCH (P-EPOCH) regimen for patients with relapse and refractory non-Hodgkin' s T-cell lymphoma (T-NHL).Methods A total of 15 patients with pathologically diagnosed T-NHL from January 2010 to January 2014 of the Beijing Military Region General Hospital who had been treated with CHOP or CHOP-like regimens were relapse or refractory.They were treated by P-EPOCH regimen [VP16 50 mg/m2,E-ADM 12 mg/m2,VCR 0.4 mg/m2,dissolved in 500 ml saline sustained static drops 24 h on day 1 to 4;CTX 750 mg/m2,intravenous injection on day 5;pegaspargase 2 500 U ·m-2·d-1 given as intramuscular injection on day 6;oral prednisone 60 mg/m2 on day 1 to 6;21 days of a cycle].Results All the 15 patients were treated by P-EPOCH regimen.The response rate of the whole group was 66.7 ％,including CR 4 cases (26.7 ％) and PR 6 cases (40.0 ％).The median survival time was 20 months (5-30 months),and (2-year) overall survival rate was 46.6 ％.Main side effects were myelosuppression,liver dysfunction and disturbance of blood coagulation.Conclusion PEPOCH regimen is effective for patients with relapse and refractory T-NHL and has better tolerance,and worthy of clinical study.