剂量调整的EPOCH方案治疗初治血管免疫母T细胞淋巴瘤的前瞻性研究.docx

剂量调整的EPOCH方案治疗初治血管免疫母T细胞淋巴瘤的前瞻性研究仲凯励苏航肖秀斌刘静鲁云陈喜林达永路春蕾张伟京摘要目的：前瞻性研究剂量调整的EPOCH方案对初治血管免疫母T细胞淋巴瘤（AITL）患者的疗效及不良反应。方法：选择2008年9月至2012年9月中国军事医学科学院附属307医院确诊的初治AITL患者9例。全组患者均接受剂量调整的EPOCH方案一线化疗。结果：全组患者发病中位年龄54岁，男∶女为2∶1，88.9%为Ann-ArborstageⅢ～Ⅳ期，77.8%合并B症状。初诊时伴有贫血的患者占66.7%，LDH或β2微球蛋白升高占55.6%。EPOCH方案近期疗效CR率22.2%，总反应率66.7%。中位随访20个月，4年PFS和OS分别为11.1%和33.3%，中位生存时间19个月。EPOCH方案化疗主要不良反应为血液学毒性，3～4度粒细胞减少和血小板减少分别为77.8％和33.3%，44.4%的患者出现粒细胞缺乏伴发热。结论：剂量调整的EPOCH方案一线治疗AITL患者较传统CHOP方案未见明显生存获益。主要不良反应为血液学毒性，并可以耐受。关键词血管免疫母T细胞淋巴瘤EPOCH方案初治化疗doi:10.3969/j.issn.1000-8179erspectiveresearchofpreliminarilydiagnosedangioimmunoblasticT-celllymphomawithdose-adjustedEPOCHregimenKailiZHONG,HangSU,XiubinXIAO,JingLIU,YunLU,XilinCHEN,YongDA,ChunleiLU,WeijingZHANGCorrespondenceto:WeijingZHANG;E-mail:zhangwj3072@163.comDepartmentofLymphoma,No.307HospitalofMilitaryMedicalScienceAcademyofthePLA,Beijing100071,China.AbstractObjective:Theeffectandsideeffectofthedose-adjustedEPOCHregimenwereevaluatedperspectivelyforthepre-liminarilydiagnosedangioimmunoblasticT-celllymphoma.Methods:NinecasesofuntreatedangioimmunoblasticT-celllymphomawerediagnosedandenrolledinourdepartmentfromSeptember2008toSeptember2012.Allpatientsreceiveddose-adjustedEPOCHregimenasfirst-linechemotherapy.Results:Themedianageof9patientswas54years.Themale-to-femaleratiowas2∶1.About88.9%ofallpatientswereatAnnArborstageⅢ/Ⅳ,and77.8%presentedwithBsymptoms.Anemiawasfoundin66.7%of9patients,andlactatedehydrogenaseelevatedin55.6%ofpatients.Afteranaverageof4.7cyclesofchemotherapyofdose-adjustedEPOCHregi-men,thecompleteremissionratewas22.2%,andthetotalresponseratewas66.7%.Withamedianfollow-upof20months,the4-yearprogression-freesurvivalratewas11.1%,andtheoverallsurvivalratewas33.3%.Themediansurvivaltimewas19months.ThemostcommonadverseeventsofEPOCHchemotherapywerehematologictoxicity.Grades3-4neutropeniaandthrombocytopeniawerere-portedin77.8%and33.3%ofpatients.Febrileneutropeniawasobservedin44.4%ofpatients.Non-treatment-relatedmortalitywasal-sonoted.Conclusion: