GOX 方案与DICE方案二线治疗非霍奇金淋巴瘤的临床对比研究

Comparison of the Effect of GOX and DICE Regimen on non-Hodgkin's Lymphoma as the Second-line Treatment

    摘要
  • 摘要: 目的：对比奥沙利铂联合吉西他滨（GOX）与DICE方案二线治疗复发性或难治性非霍奇金淋巴瘤（NHL ）的疗效及毒副作用。方法：选取复发难治性非霍奇金淋巴瘤患者55例，随机分为两组，分别接受GOX方案和DICE方案化疗。GOX组方案为：GEM1 000mg/m2，静脉滴注，d1、d8，LOHP 130mg/m2，静脉滴注，d1；21d 为1 个周期。DICE组方案为: 地塞米松（DXM）20mg，静脉滴注，d1～d4；异环磷酰胺（IFO ）1g/m2，静脉滴注，d1～d4；Mesna解救400mg，静脉滴注q8h，d1～d4；顺铂（DDP ）25mg/m2，静脉滴注，d1～d4；依托泊苷（Vp- 16）100mg/m2，静脉滴注，d1～d4。21～28d 为1 个周期。每2 周进行疗效及毒性评价。结果：55例患者中，GOX方案组CR3 例（11.5%），PR14例（53.8%），SD5 例，PD4 例，总有效率（CR+PR）为65.4% ，临床获益率（CR+PR+SD ）达到84.6% 。DICE组CR4 例（13.8%），PR12例（41.4%），SD8 例，PD5 例，总有效率55.2% ，临床获益率82.7% 。针对不同的细胞类型，GOX组中T 细胞淋巴瘤患者总有效率为60.0% ，B 细胞淋巴瘤总有效率达68.8% ，在DICE组T 细胞淋巴瘤总有效率50.0% ，而B 细胞淋巴瘤为57.9% 。两组的毒副反应主要为骨髓抑制，其中GOX组白细胞下降Ⅲ度7 例，Ⅳ度2 例；贫血Ⅲ度2 例；血小板下降Ⅲ度5 例，Ⅳ度2 例。DICE组白细胞下降Ⅲ度12例，Ⅳ度4 例；贫血Ⅲ度2 例；血小板下降Ⅲ度3 例，Ⅳ度1 例。胃肠道反应较GOX组为重，Ⅲ度2 例，Ⅳ度1 例。比较两组毒副反应，GOX组在中性粒细胞减少，消化道反应方面明显好于DICE组（P<0.05）。 而DICE组出现未出现末梢神经毒性病例。结论：GOX方案二线治疗复发或难治性非霍奇金淋巴瘤是较为安全且有效的化疗方案，其远期疗效尚需进一步观察。

     

    Abstract: Objective: To compare the efficacy and safety of GOX and DICE regimen for relapsed or refractory non-Hodgkin's lymphoma (NHL). Methods:A total of55cases of relapsed and refractory NHL were randomly divided into two groups and received GOX and DICE treatment, respectively. The GOX regimen included GEM 1000mg/m2, ivd, d1, 8;L-OHP130 mg/m2, ivd, d1; 21d per cycle. The DICE regimen included DXM 20mg, ivd, d1-d 4; IFO 1g/m2, ivd, d1-4; Mesna 400 mg, ivd q8h, d 1-d 4; DDP 25mg/m2, ivd, d1-d 4; Vp-16100 mg/m2, ivd, d1-d 4, 21-28d per cycle. The efficacy and safety were evaluated every two weeks. Results:In GOX group, there were 3 CR cases ( 11.5%),14PR cases ( 53.8%),5 SD cas-es, and 5 PD cases. The total response rate (CR+PR) was 65.4%, and the clinical benefit rate (CR+PR+ SD) was84.6%. In DICE group, there were 4 CR cases (13.8%),12PR cases (41.4%),8 SD cases, and 5 PD cases. The total response rate (CR+PR) was 55.2%, and the clinical benefit rate (CR+PR+SD) was82.7%. The main side effect was bone marrow suppression. In GOX group, there were 7 cases with leukopenia Ⅲ, 2 cases with leukopenia Ⅳ; 2 cases with anemia Ⅲ, 5 cases with thrombocytopenia Ⅲ, and 2 cases with thrombocytopenia Ⅳ. In DICE group, there were 12cases with leukope-nia Ⅲ, 3 cases with leukopenia Ⅳ, 2 cases with anemia Ⅲ, 3 cases with thrombocytopenia Ⅲand 1 case with thrombocy-topenia Ⅳ. The gastrointestinal tract reaction was more serious in DICE group than in GOX group, with 2 cases of Ⅲand 1 case of Ⅳ. Conclusion:GOX is a safer and more effective regimen for relapsed or refractory NHL, and its long-term effect needs to be further investigated.

     

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