DHAP方案治疗复发和难治性中、高度恶性非霍奇金淋巴瘤的初步观察

背景和目的:复发和耐药非霍奇金淋巴瘤的治疗十分棘手,国外文献报道DHAP方案取得较好疗效,但国内尚未见报道。我们采用DHAP方案治疗复发和难治性非霍奇金淋巴瘤,进一步评价该方案的疗效及毒性。方法:17例复发和10例难治性非霍奇金淋巴瘤患者接受DHAP方案(顺铂20mg/m2,第1～5天;阿糖胞苷1g/m2,q12h,第1～2天;地塞米松40mg,第1～4天)化疗,3～4周重复一次。4例患者进一步进行了自体外周血干细胞移植支持下的超大剂量化疗。结果:CR8例(29.6%),PR4例(14.8%),有效率为44.4%(12/27)。有效患者中位缓解时间4.8个月。DHAP方案治疗后中位生存时间8.3个月,1年生存率为30.8%,2年生存率为19.3%。主要不良反应为骨髓抑制,主要表现为白细胞下降和血小板下降,Ⅲ～Ⅳ度白细胞下降占59.3%(16/27),其中3例(11.1%)患者因粒细胞缺乏出现感染性发热;Ⅲ～Ⅳ度血小板下降占81.5%(22/27),5例(18.5%)患者进行了预防性血小板输注。结论:DHAP是治疗复发和难治性中高度恶性非霍奇金淋巴瘤的有效方案,但仍存在有效率较低,缓解期较短的缺点,且骨髓毒性严重,尤其是血小板和白细胞下降。对于敏感复发的患者,DHAP方案取得完全缓解后,应争取行外周血干细胞移植支持下的大剂量化疗,以延长缓解期和提高长期生存率。

Preliminary study on DHAP regimen for patients with relapsed and refractory non-Hodgkin's lymphoma

BACKGROUND AND OBJECTIVE: The treatment of the patients with relapsed and refractory non-Hodgkin's lymphoma(NHL) remains difficult. It was reported that DHAP regimen(cisplatin + Ara-C + dexamthsone) was an effective salvage therapy, but there was no report about it in China. The current study was designed to observe the efficacy and toxicity of DHAP regimen for the patients with relapsed and refractory NHL. METHOD: Seventeen patients with relapsed and 10 with refractory intermediate or high grade NHL was involved in this study. These patients were treated with cytarabine 1 g/m2 intravenous(i.v.) every 12 hours on day 1 to 2, cisplatin 20 mg/m2 i.v. on day 1 to 4, dexamethone 40 mg i.v. on day 1 to 4. Four patients with CR after DHAP were followed by autologous peripheral blood stem cell transplantation(APBPCT). RESULTS: Overt responses to DHAP were seen in 12 patients (44.4%) including 8 complete responses(CR) (29.6%) and 4 partial responses (PR) (14.8%). The effective release time lasted a median of 4.8 months. Median survival time was 8.3 months. 1-year and 2-year survival rate were 30.8% and 19.3%, respectively. Myelosuppression was the major toxicity; 15 patients(57.7%) had grade III-IV neutropenia and 21 patients (80.8%) had grade III-IV thromcytopenia, but there was no treatment-related death. CONCLUSION: The authors conclude that DHAP regimen is an effective salvage therapy for the patients with relapsed and refractory NHL, but the remission duration time is short and long-term prognosis remains poor. High dose chemotherapy supported by APBPCT is necessary for improvement in long-term survival.