门冬酰胺酶联合GDP方案治疗结外NK/T细胞淋巴瘤的临床疗效观察

左文丽; 邓梅; 尹青松; 杜建伟; 朱兴虎

doi:10.3969/j.issn.1000-8179.2017.07.467

门冬酰胺酶联合GDP方案治疗结外NK/T细胞淋巴瘤的临床疗效观察

Clinical efficacy and safety of L-asparaginase combined with GDP regimen in treatment of patients with extranodal NK/T-cell lymphoma

摘要

摘要:
目的观察左旋门冬酰胺酶（L-asparaginase，L-ASP）联合GDP方案治疗结外NK/T细胞淋巴瘤extranodal natural killer（NK）/T-cell lymphoma，ENKL的临床疗效及不良反应。
方法分析2012年1月至2014年1月间郑州大学附属肿瘤医院收治的初治结外鼻腔NK/T细胞淋巴瘤39例，采用L-GDP方案治疗，具体剂量为左旋门冬酰胺酶6 000/m²，qod×8，d1开始；吉西他滨1 000 mg/m²，d1，8；顺铂90 mg/m²，d1；地塞米松10 mg，d1~4，每21 d为1个周期，完成所有疗程后评价疗效，每周期评价不良反应发生情况，化疗后根据分期选择是否联合放疗或自体移植，观察疗效及不良反应。
结果 39例患者接受中位6个周期L-GDP方案化疗，完全缓解（complete response，CR）为24例，部分缓解（partial response，PR）为7例，疾病稳定（stable disease，SD）为6例，疾病进展（progressive disease，PD）为2例，总有效率（RR=CR+PR）为79.5%（31/39），全组患者2年无进展生存期（progression-free survival，PFS）为71.8%（28/39），总生存期（overall survival，OS）为87.2%（34/39）。主要不良反应为胃肠道反应和骨髓抑制及轻度凝血功能异常，25例（64.1%）患者出现恶心呕吐，均能耐受。Ⅲ、Ⅳ度白细胞减少和血小板减少发生率为15.4%（6/39），82.1%（32/39）的患者出现凝血酶原时间（prothrombin time，PT）、活化部分凝血酶原时间（activated partial prothrombin time，APPT）轻度延长，可自行恢复。未有因严重不良反应而中断治疗者。
结论 L-GDP方案是鼻腔NK/T细胞淋巴瘤安全有效的治疗方案。

Abstract:
Objective To evaluate the clinical efficacy and safety of L-asparaginase (L-ASP) combined with GDP regimen in initial treatment of patients with extranodal NK/T-cell lymphoma (ENKL).
Methods A total of 39 patients preliminarily diagnosed with nasal NK/Tcell lymphoma in Zhengzhou University Affiliated Cancer Hospital were retrospectively analyzed from January 2012 to January 2014. All patients received L-ASP combined with GDP chemotherapy. The efficacy of the treatment was observed (L-ASP 6 000/m², qod×8; gemcitabine 1 000 mg/m², d1, 8; cisplatinum 90 mg/m², d1; dexamethasone 10 mg, d1-4) every 21 days for one cycle. The efficacy and toxicity of the regimen were evaluated after therapy.
Results Of the 39 patients who received median six-cycle L-GDP regimen treatment, 24 achieved complete response, 7 had partial response, 6 had stable disease, and 2 had progressive disease. The rates of overall response (CR+PR), 2-year progression-free survival, and overall survival were 79.5% (31/39), 71.8% (28/39), and 87.2% (34/39), respectively. The primary side effects included gastrointestinal reaction, bone marrow suppression, and increased PT and APPT levels. All patients tolerated and completed the therapy without termination of treatment and death.
Conclusion L-ASP combined with GDP regimen is effective and safe and thus can be used for patients with ENKL.

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