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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。
Objective To evaluate the efficacy and adverse reactions of fludarabine-based chemotherapy in the treatment of low-grade lymphomas. Methods Fludarabine-based chemotherapy regimens (FMD regimen: fludarabine + mitoxantrone + dexamethasone; FMC regimen: fludarabine + mitoxantrone + cyclophosphamide; FC regimen: fluoride 32 cases of low grade malignant non-Hodgkin’s lymphoma admitted to our hospital, including 19 cases of initial, 13 cases of recurrence and refractory. Results 32 patients completed an average of 4.1 courses of treatment. The complete remission (CR) rate was 65.6%, the partial remission (PR) rate was 18.8% and the total effective rate (OR) was 84.4%. The CR rate was 71.4%, the PR rate was 21.0%, the OR rate was 92.4% in the initial treatment group, the CR rate was 46.2% in the relapsed and refractory group, the PR rate was 13.1% and the OR rate was 59.3%. There was no significant difference in CR rate and OR rate between the two groups (P> 0.05). The main adverse reactions are myelosuppression and immune suppression. Grade III-IV neutropenia occurred in 31.3% (10/32) of patients and Grade III to IV thrombocytopenia occurred in 9.4% (3/32) of patients. Seven patients developed infection and fever, and two of the patients with pulmonary infection died. Non-hematological toxicity mainly gastrointestinal reactions and mild liver and kidney dysfunction. The median follow-up time was 16 months (range 1 to 30 months), 2-year OS (93.8 ± 4.2)%, and 2-year disease progression-free survival (PFS) 84.4 ± 6.3%. The 2-year OS rate was 100% in the primary group and 94.7 ± 5.0% in 2 years. The 2-year OS rate was (76.9 ± 11.3)% in the relapsed and refractory group and (69.2 ± 12.3) %, No significant difference between the two groups (P> 0.05). Conclusions Fludarabine-based chemotherapy is better tolerated and has a better effect on low-grade lymphoma, which may improve the prognosis of patients.