改良ＥＳＨＡＰ方案治疗复发和难治性中度侵袭性非霍奇金淋巴瘤的临床观察

目的：观察改良的ＥＳＨＡＰ方案治疗复发和难治性中度侵袭性非霍奇金淋巴瘤（ＮＨＬ）的疗效及安全性。方法：１６例复发和１２例难治性中度侵袭性ＮＨＬ患者接受改良的ＥＳＨＡＰ方案化疗（替尼泊苷６０ｍｇ／ｍ２静滴，第２～５天；甲强龙５００ｍｇ静滴，第１～５天；阿糖胞苷１ｇ／ｍ２静滴，第１天；顺铂：２０ｍｇ／ｍ２静滴，第２～５天），２１～２８天为１周期，按ＷＨＯ标准评价疗效和毒副反应。结果：２８例中ＣＲ１０例，ＰＲ８例，ＳＤ６例，总有效率为６４.３％。主要毒副反应为骨髓抑制，表现为白细胞减少和血小板减少，其中Ⅲ度白细胞减少为８例，占２８.６％，Ⅳ度为１１例占３９.３％，４例因中性粒细胞减少而出现感染性发热；Ⅲ度血小板减少８例，占２８.６％，Ⅳ度为６例，占２１.４％，４例进行了预防性血小板输注。可逆的Ⅰ度肾功能损伤３例。中位缓解期为６个月（１～１６个月），中位ＴＴＰ为５个月（２～２４个月），ＭＳＴ为１８个月（３～５１个月），３年生存率为２９.０％，３年无病生存率为１７.９％。结论：改良的ＥＳＨＡＰ方案是治疗复发和难治性中度侵袭性ＮＨＬ的有效的解救方案，与传统的ＥＳＨＡＰ方案比较，毒副反应较轻，尤其是骨髓抑制可以接受。

Clinical observation of modified ESHAP as salvage chemotherapy for recurrent or refractory intermediate invasive non-Hodgkin's lymphoma

Objective ： To evaluate efficacy and toxicities of modified ESHAP regimen as salvage chemotherapy for recurrent or refraetnry intermediate invasive non-Hodgkin＇s lymphoma（NHL）. Methods： Sixteen recurrent patients and 12 refractory patients with intermediate invasive NHL were treated with modified ESHAP regimen （ teniposide 60 mg/m2 , days 2-5 ; methylprednisolone 500 mg, days 2-5 ;cytarabine lg/m2 day 1 ;eisplatin20mg/m2 ,days 2-5 ） ,21-28 days percycle. Evaluate efficacy and toxicities on the basis of the World Health Organization criteria. Results：Ten patients（35.7% ） had a complete response,8 patients（28.6% ） had a partial response and 6 patients （21.4%） had a stabilize disease. Overall response rate was 64. 3%. The main toxicities were myelosuppression, such as neutropenia and thrombocytopenia, 8 patients （28.6%） and Ⅱ patients （ 39. 3% ） had grade Ⅲ and Ⅳneutropenia, among them 4 patients had fever caused by infection ; 8 patients（28.6% ） and 6 patients（21.4% % ） had grade Ⅲ and Ⅳ thrombocytopenia, of them 4 patients had prophylactic platelet transfusions; 3 patients（ 10. 7% ） had convertible Ⅰ grade renal function injuries. Median response time was 6months （ranged 1-16 months）, median time to failure was 5 months （ranged 2-24 months）, median survival time was 18months（ ranged 3-51 months）,3-year overall survival rate was 29.0% ,3-year disease free survival rate was 17.9%. Conclusion： The modified ESHAP regimen was effective salvage chemotherapy for recurrent or refractory intermediate invasive NHL. Comparison to traditionary ESHAP, toxic reaction was more slighter, especially myelosuppression was respectable.