结外NK/T细胞淋巴瘤L-GEMOX方案治疗的临床观察

摘要

Objective:To observe the therapeutic efficacy and security of the L-GEMOX regimen in extranodal NK/T-cell lymphoma. Methods:Thirty-two patients with diagnoses of morphological and immunohistochemical ex-tralnodal NK/T-cell lymphoma were treated by L-GEMOX regimen,twenty-one days as one cycle. All patients re-ceived at least 2 cycles chemotherapy. The regimen was administered for 4 cycles and the response rate was evaluated. After induced chemotherapy addtionnal involved-fieled sequential irradiation was administered. Results:There were 17 cases of CR(53. 1%),10 cases PR(31. 3%),3 cases SD(9. 4%),2 case PD(6. 3%). After radiotherapy there were 20 cases of CR(62. 5%),12 cases PR(37. 5%)and efficiency was 100%. Primary site and clinicla stage were associated with short-term efficacy(P<0. 05). Major adverse reactions were myelo-suppression,mucosctis,elevat-ed aminotransferases and blood glucose fluctuations,no treatment-related deaths occurred. Conclusion:Combined treatment of gemcitabine,oxaliplatin and Pei enzymes as first-line induction chemotherapy is effective and well toler-ant for eatralnodal NK/T-cell lymphoma. It may be a new treatment option forⅠ,Ⅱof nasal NK/T-cell and need to be carried out By large prospective study to assess the possibility of improving overall survival and disease-free survive of extralnodal NK/T-cell lymphoma.%目的：观察L-GEMOX方案对结外NK/T细胞淋巴瘤的近期疗效和安全性。方法：回顾性分析32例经病理形态学及免疫组化证实为结外NK/T细胞淋巴瘤患者，均接受L-GEMOX方案治疗，至少接受2个周期。32例患者接受4个周期化疗后行疗效评价，诱导化疗后行序贯累计野放疗。结果：32例结外NK/T细胞淋巴瘤患者中，诱导化疗后完全缓解（CR）率为53.1％（17/32），部分缓解（PR）率为31.3％（10/32），疾病稳定（SD）率为9.4％（3/32），疾病进展（PD）率为6.3％（2/32）。完成放射治疗后，CR率为62.5％（20/32）， PR率37.5％（12/32），有效率为100％。临床特征分析显示原发部位、临床分期与患者近期疗效相关（P＜0.05）。主要不良反应为骨髓抑制、黏膜炎、转氨酶升高及血糖波动等，多为轻中度，予对症处理或化疗停止后很快缓解。无治疗相关死亡。结论：培门冬酶及吉西他滨联合奥沙利铂（ L-GEMOX）作为一线诱导化疗方案，对结外NK/T细胞淋巴瘤的近期疗效佳，不良反应轻，安全性好，是Ⅰ期、Ⅱ期鼻NK/T细胞淋巴瘤新的治疗选择。将来需进一步开展大样本的前瞻性研究，评估L-GEMOX方案能否改善结外NK/T 细胞淋巴瘤的总生存期和无病生存期。