氟达拉滨联合化疗治疗20例初治边缘区淋巴瘤的临床观察

涂梅峰; 郑文; 张运涛; 王小沛; 宋玉琴; 谢彦; 林宁晶; 平凌燕; 应志涛; 刘卫平; 邓丽娟; 张晨; 朱军

doi:10.3969/j.issn.1000-8179.2011.05.013

摘要: 目的：探讨氟达拉滨联合化疗方案治疗初治边缘区B细胞淋巴瘤的疗效和不良反应。方法：2005年9月至2010年2月期间，收治经北京肿瘤医院确诊的初治边缘区B细胞淋巴瘤患者20例，其中结外、结和脾边缘区淋巴瘤分别为16例、3例和1例。治疗方法均采用含氟达拉滨的方案，其中采用FC方案（氟达拉滨+环磷酰胺）治疗14例，采用Rituximab （利妥昔单抗，R） -FC治疗6例。所有患者均接受1～6个周期化疗，平均完成为4.3个周期。结果：20例患者中达完全缓解者18例（90%），达部分缓解者2例（10%），总有效率（完全缓解+部分缓解）为100%。所有患者的1年和2年总生存率均为88%， 1年和2年无进展生存率均为88%， 1年和2年的无瘤生存率均为85%。全组共化疗86个周期，主要不良反应为骨髓抑制和轻度胃肠道反应。51%周期发生白细胞下降，其中9.3%周期发生Ⅲ/Ⅳ度白细胞减少； 6例（30%）患者出现血小板下降，年龄≥60岁患者中血小板下降发生率为66.7% （4/6），而<60岁患者中血小板下降发生率为14.3% （2/14），P=0.037； 20%周期发生胃肠道反应； 8%周期发生轻度肝功能损伤； 1例（5%）患者合并肺部真菌感染。结论：氟达拉滨联合环磷酰胺对初治边缘区B细胞淋巴瘤的近期疗效较好，不良反应可耐受，远期疗效值得期待。

Abstract: Efficacy of Fludarabine–based Combination Chemotherapy in 20 Patients UndergoingInitial Treatment of Marginal Zone B-cell LymphomaMeifeng TU, Wen ZHENG, Yuntao ZHANG, Xiaopei WANG, Yuqin SONG, Yan XIE, Ningjing LIN, Lingyan PING, Zhitao YING,Weiping LIU, Lijuan DENG, Chen ZHANG, Jun ZHUCorrespondence to: Jun ZHU, E-mail: zj@bjcancer.orgDepartment of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking UniversitySchool of Clinical Oncology, Beijing Cancer Hospital, Beijing Institute for Cancer Research, Beijing 100142, ChinaAbstract Objective: To evaluate the efficacy and safety of fludarabine-based combination chemotherapy in 20 patients undergo-ing initial treatment for marginal zone B-cell lymphoma ( MZL ). Methods: Data of 20 patients with initial treatment of MZL in thestudy hospital between September 2005 and February 2010, including 16 with extranodal MZL, 3 with nodal MZL and 1 with splenicMZL, were reviewed in this study. A fludarabine-based regimen was administered in all patients. Specifically, 14 patients were treatedwith a FC regimen (Fludarabine and cyclophosphamide) while 6 were treated with R-FC ( Rituximab + FC ). On average the patients re-ceived 4.3 ( 1~6 ) therapeutic cycles. Results: Eighteen of the 20 patients ( 90 % ) achieved complete remission (CR) and the other 2 pa-tients ( 10 % ) achieved partial remission ( PR ). The total effective rate ( CR + PR ) was 100 % ( 20/20 ). In all 20 patients, the 1- and2-year overall survival rates were 88 %, the progression-free survival ( PFS ) rate was 88 % and the disease-free survival rate was 85 %.Myelosuppression and mild GI toxicity were the major side effects. The rates of leucopenia, nausea and vomiting and mild liver injurywere 51 % ( Ⅲ+Ⅳ 9.3 % ), 20%, and 8%, respectively. Six patients ( 30 % ) had thrombocytopenia; the incidence of thrombocytopeniawas 66.7% (4/6) in patients over 60 years old and 14.3% (2/14) in patients younger than 60 years old ( P = 0.037 ). Pulmonary fungal in-fection occurred in 1 patient ( 5 % ). Conclusion: The fludarabine-based chemotherapy regimen has shown a satisfactory therapeutic ef-fect on patients undergoing initial treatment for MZL, and the corresponding side effects can be well tolerated.Keywords Lymphoma; Marginal zone B-cell; Fludarabine; Combination chemotherapy