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背景和目的:复发或耐药非霍奇金淋巴瘤(non-Hodgkinslymphoma,NHL)是肿瘤化疗的难点之一,目前尚无标准的解救方案。临床前研究和临床研究均证明部分抗癌药物持续静脉灌注可提高疗效或降低毒性,本试验的目的为观察用EPOCH方案持续静脉灌注治疗NHL患者的疗效和不良反应。方法:2001年6月到2002年6月共收治26例复发或耐药中高度恶性NHL,其中20例(84.7%)患者至少接受2个化疗方案的治疗,中位方案数2(1～6)个,中位疗程数8(3～16)个,15例(65.7%)患者复发耐药;采用含蒽环类药物连续静脉滴注的方案EPOCH(VP-16、EPI/ADM、VCR、CTX、Prednisone)化疗1～6个疗程(中位2个疗程)。结果:本组26例患者均可评价疗效和不良反应,总的客观有效率50%,完全缓解率19.2%,其中T细胞来源NHL有效率为28.6%,B细胞来源NHL为57.9%。26例患者共实施46个疗程化疗,主要不良反应为骨髓抑制,其中Ⅲ～Ⅳ度粒细胞减少发生率为34.8%,Ⅲ～Ⅳ度血小板减少发生率为8.7%,其他不良反应少见。结论:EPOCH是复发或耐药中高度恶性NHL经济有效的解救方案,值得进一步研究推广。
BACKGROUND & OBJECTIVE: Non-Hodgkinslymphoma (NHL) is one of the difficulties of chemotherapy for cancer. There is no standard rescue plan. Preclinical studies and clinical studies have shown that continuous intravenous infusion of some anticancer drugs can improve the efficacy or reduce toxicity. The purpose of this experiment is to observe the efficacy and adverse reactions of continuous intravenous infusion of EPOCH regimen in patients with NHL. Methods: From June 2001 to June 2002, 26 patients with recurrent or drug resistant middle and high grade NHL were enrolled. Among them, 20 (84.7%) patients received at least 2 chemotherapy regimens, with a median of 2 (1-6) (N = 15) (65.7%) were treated with EPOCH (VP-16, EPI / ADM, VCR, CTX, Prednisone) Chemotherapy 1 to 6 courses (median 2 courses). Results: Twenty-six patients in our study were able to evaluate the efficacy and adverse reactions. The total effective rate was 50% and the complete remission rate was 19.2%. The effective rate of NHL for T cells was 28.6% and that for B cells was 57.9%. Twenty-six patients received 46 courses of chemotherapy. The main adverse reactions were myelosuppression. The incidence of grade Ⅲ-Ⅳ neutropenia was 34.8%, and the incidence of grade Ⅲ-Ⅳ thrombocytopenia was 8.7%. Other adverse reactions were rare. Conclusion: EPOCH is a cost-effective and effective rescue plan for recurrent or drug resistant NHL. It is worth further study and promotion.