HyperCVAD方案和CHOP方案治疗淋巴母细胞淋巴瘤的效果分析

Comparison of HyperCVAD Regimen and CHOP Regimen in Treating Patients with Lymphoblastic Lymphoma

中文关键词:  HyperCVAD CHOP 淋巴母细胞淋巴瘤 疗效

英文关键词:HyperCVAD CHOP Lymphoblastic lymphoma Outcome

中文摘要:

      目的 比较HyperCVAD方案和CHOP方案对淋巴母细胞淋巴瘤的治疗效果。方法 回顾性收集2002年1月至2013年10月我院血液科收治的75例采用HyperCVAD方案（HyperCVAD组，n=44）和CHOP方案（CHOP组，n=31）治疗的淋巴母细胞淋巴瘤患者的临床资料,Logistic回归分析影响完全缓解（CR）的因素。随访终点时间为2013年12月31日，进行生存分析，COX回归分析总生存时间（OS）的影响因素。结果 8个疗程之后，HyperCVAD组CR率（73%）和治疗总有效率（91%）高于CHOP组的23%和46%（P<0.000 1）。中位随访时间为9.9个月（1.3~41个月）。HyperCVAD组患者的中位OS时间为31.5个月，中位疾病无进展（PFS）时间为16个月，长于CHOP组的11个月和5个月（P均<0.05）。Logistic回归发现HyperCVAD组中， 乳酸脱氢酶 (lactate dehydrogenase，LDH)升高〔标准偏回归系数(β)=-0.479〕和国际预后指数（international prognostic index，IPI）≥3分（β=-0.691）是CR的负性影响因素。COX回归发现患者经过治疗后获得CR是唯一与长期生存相关的预后因素（相对危险度= 0.146，95%可信区间 0.044~0.488）。两组方案治疗的不良反应主要为骨髓抑制、肺部感染和肝功能异常等。HyperCVAD组中，100%的患者出现Ⅲ~Ⅳ级的血液学毒性，并有27%患者出现严重的肺部感染，明显高于CHOP治疗组的84%和3%（P均<0.05）。两组均无患者因不良反应而死亡。结论 HyperCVAD方案与CHOP方案相比，疗效和预后均得到改善，肺部感染率较高但可耐受，是治疗淋巴母细胞淋巴瘤的有效方案。

英文摘要:

      Objective To compare the efficacy and safety of HyperCVAD regimen and CHOP regimen in treating patients with lymphoblastic lymphoma (LBL). Methods Seventy-five LBL patients were enrolled from January 2002 to October 2013, with 44 being treated with HyperCVAD and 31 being treated with CHOP regimen. The patients were followed up until 31 December 2013. Factors associated with the prognosis of the patients were analyzed using Logistic and COX regression models. Results The complete remission rate (73% vs. 23%) and overall response rate (91% vs. 46%) were both significantly higher in the patients receiving HyperCVAD regimen compared with those receiving CHOP regimen (P<0.000 1). The follow-up lasted on average (median) 9.9 months (ranging from 1.3 to 41 months). The patients receiving HyperCVAD regimen had significantly longer overall survival (OS) (median 31.5 vs. 11 months, P=0.012 7) and progression-free survival (PFS) time (median 16 vs. 5 months, P=0.000 4) than those receiving CHOP regimen. Complete remission (CR) was negatively associated with increased lactate dehydrogenase 〔LDH, standard partial regression coefficent (β)=-0.479〕 and international prognostic index (IPI score≥3, β=-0.691) in the patients receiving HyperCVAD regimen. The only significant predictor for survival was CR 〔relative risk (RR)=0.146，95% confidence interval (CI): 0.044-0.488〕. Common adverse events of the two regimens were bone marrow suppression, pulmonary infection, liver dysfunction and hemorrhage. Patients receiving HyperCVAD regimen were more likely to suffer from bone marrow suppression (100% vs. 84%) and severe pulmonary infection (27% vs. 3%) than those receiving CHOP regimen (P<0.05). No patient died of those adverse events. Conclusion Compared with CHOP regimen, HyperCVAD regimen can improve response rates and survival of LBL patients. Its higher level of pulmonary infection can be managed.