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。

Comparing CVDLP with CHOP in Induction Treatment for Patients with Advanced Lymphoblastic Lymphoma

Objective: This study was designed to improve complete remission(CR) rate in the patients with advanced lymphoblastic lymphoma by using early extensive induction chemotherapy. Method:A total of 11 cases of untreated lymphoblastic lymphoma in Stage Ⅲ /Ⅳ were received CVDLP regimen, including cytoxan(CTX) 1000 mg/m2 d1， vincristine(VCR) 1.5 mg/m2 d1,d8,d15,d21， Adriamycin(ADR) 40 mg/m2 d1， d2， d21， L-asparaginase(L-ASP) 10000 U/m2 d15～24， Prednison 60 mg/m2 d1～28， gradually decreased dosage at d15. methotrexate＋ Ara-C IT qw× 4. Efficacy were evaluated at d28～35. Simultaneously,retrospective analysis for 9 cases of untreated lymphoblastic lymphoma in Stage Ⅲ /Ⅳ treated with 2 cycles of CHOP were made. Efficacy were evaluated at d35. Results: CVDLP group: 10/11 cases of patients achieved CR, and 1/11 case had PR, rate of complete remission was 90.9％ ;10/11 cases had Grade Ⅳ hematological toxicity,1/11 cases had Grade Ⅲ hematological toxicity(WHO). CHOP group:3/9 got CR;5/9 got PR;1/9 had MR,rate of complete remission was 33％ . 3/9 had Grade Ⅲ hematology toxicity;6/9 had GradeⅡ hematological toxicity. Conclusion:CVDLP regimen can induce higher CR rate than CHOP regimen in untreated lymphoblastic lymphoma with Stage Ⅲ /Ⅳ , but hematology toxicity was also higher than CHOP regimen. However this induction regimen is safe and viable with strengthening supportive care.