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目的:比较HLH-2004与COP方案治疗继发性噬血细胞性淋巴组织细胞增多症(sHLH)患者疗效与不良反应。方法:38例sHLH患者随机分入HLH-2004与COP组,HLH-2004组18例,COP组20例,比较2组疗效与不良反应。结果:HLH-2004组完全缓解(CR)率38.9%,总体反应(RR)率72.2%;COP组CR率45%,RR率80%,2组差异无统计学意义(P>0.05)。对患者进行病因分析,2组差异无统计学意义(P>0.05)。HLH-2004组白细胞下降发生率Ⅲ～Ⅳ度为61.1%、血小板下降发生率Ⅲ～Ⅳ度为83.3%,均明显高于COP组的15%、25%,差异有统计学意义(P<0.05),而2组间的感染发生率比较差异无统计学意义。HLH-2004组患者中位生存时间62(12～186)周,1年OS率55.6%;COP组患者中位生存时间55(2～204)周,1年OS率68.6%,2组差异无统计学意义(P>0.05)。结论:COP方案治疗sHLH患者疗效与HLH-2004相当,但不良反应相对较少,对于无法耐受较大剂量化疗的患者,COP方案是一个良好的选择。
Objective: To compare the efficacy and side effects of HLH-2004 and COP regimens in the treatment of patients with secondary hemophagocytic lymphohistiocytosis (sHLH). Methods: Thirty-eight patients with sHLH were randomly divided into HLH-2004 group and COP group, 18 cases in HLH-2004 group and 20 cases in COP group. The curative effect and adverse reactions of the two groups were compared. Results: The complete remission (CR) rate was 38.9% and the overall response rate (RR) was 72.2% in HLH-2004 group. The CR rate in COP group was 45% and the RR rate was 80%. There was no significant difference between two groups (P> 0.05). The etiological analysis of patients, two groups showed no significant difference (P> 0.05). The incidence of leukopenia in HLH-2004 group was 61.1% and the incidence of thrombocytopenia was 83.3%, which was significantly higher than that in COP group (15%, 25%, respectively) (P <0.05 ), But there was no significant difference in the incidence of infection between the two groups. In the HLH-2004 group, the median survival time was 62 (12 to 186) weeks, and the 1-year OS rate was 55.6%. The median survival time was 55 (2 to 204) weeks in the COP group, and the 1-year OS was 68.6% Statistical significance (P> 0.05). CONCLUSIONS: COP regimen has the same efficacy as HLH-2004 in treating patients with sHLH, but with relatively fewer adverse reactions. The COP regimen is a good choice for patients who can not tolerate large doses of chemotherapy.