氟达拉滨为主的联合化疗方案治疗低度恶性非霍奇金淋巴瘤的临床观察

目的评价以氟达拉滨为主的化疗方案治疗低度恶性淋巴瘤的疗效和不良反应。方法采用氟达拉滨为主的化疗方案(FMD方案:氟达拉滨 米托蒽醌 地塞米松;FMC方案:氟达拉滨 米托蒽醌 环磷酰胺;FC方案:氟达拉滨 环磷酰胺)治疗我院收治的低度恶性非霍奇金淋巴瘤患者32例,其中初发19例,复发、难治13例。结果32例患者平均完成了4.1个疗程,完全缓解(CR)率为65.6%,部分缓解(PR)率为18.8%,总的有效(OR)率为84.4%。初发组CR率71.4%, PR率21.0%,OR率92.4%;复发、难治组CR率46.2%,PR率13.1%,OR率59.3%,两组CR率和OR率差异无统计学意义(P>0.05)。主要不良反应为骨髓抑制和免疫功能抑制。31.3%(10/32)的患者出现Ⅲ～Ⅳ级粒细胞减少,9.4%(3/32)的患者出现Ⅲ～Ⅳ级血小板减少。有7例患者出现感染、发热,其中2例肺部感染患者死亡。非血液学毒性主要为胃肠道反应及轻度的肝肾功能损害。中位随访时间16个月(1～30个月),2年总生存(OS)率(93.8±4.2)%,2年疾病无进展生存(PFS)率(84.4±6.3)%。初发组2年OS率为100%,2年PFS率为(94.7±5.0)%;复发、难治组2年OS率为(76.9±11.3)%,2年PFS率为(69.2±12.3)%,两组差异无统计学意义(P>0.05)。结论氟达拉滨为主的化疗方案患者耐受性较好,对低度恶性淋巴瘤疗效较好,有可能改善患者的预后。

A clinical observation of fludarabine-containing regimens in the treatment of low grade non-Hodgkin's lymphoma

OBJECTIVE: To evaluate the therapeutic efficiency and adverse effect of the fludarabine-containing regimens in the treatment of low grade non-Hodgkin's lymphoma. METHODS: Thirty-two patients with low grade non-Hodgkin's lymphoma consisting of 19 primary one and 13 relapsed or refractory were treated with fludarabine-containing regimens, which included FMD (fludarabine, mitoxantrone and dexamethasone); FMC (fludarabine, cyclophosphamide and mitoxantrone) and FC ( fludarabine and cyclophosphamide). RESULTS: The average course completed in these 32 patients was 4.1 with a complete response rate (CR), partial response rate (PR) and overall response rate (OR) of 65.6%, 18.8% and 84.4% , respectively. There were no significant difference in CR, PR and OR between primary and relapsed or refractory group (71.4%, 21.0%, 92.4% vs. 46.2%, 13.1%, 59.3%, respectively). Myelotoxicity and immunotoxicity was the dominating adverse effects. Ill to IV grade granulocytopenia and thrombocytopenia were observed in 31.3% (10/32) and 9.4% (3/32) of these patients respectively. Infection developed in 7 patients, and two of them died of pulmonary infection. The median follow-up period was 16 months (1-30 months) with 2-year overall-survival rate (OS) and progression-free survival rate (PFS) of 93.8% and 84.4%, respectively. No significant difference was observed between primary and relapsed or refractory group in OS (100% vs. 76.9%) and PFS (94.7% vs. 69.2%). CONCLUSION: Fludarabine-containing regimens is well tolerated and effective in the treatment of low grade non-Hodgkin's lymphoma.