Ligustrazine as a salvage agent for patients with relapsed or refractory non-Hodgkin’s lymphoma

摘要

＜正＞ Background The prognosis is poor for patients with relapsed or refractory non-Hodgkin’s lymphoma （NHL）.The mainreason for poor prognosis is multidrug resistance （MDR）,for which the main phenotype is overexpression ofP-glycoprotein （P-gp）.This study explored the efficacy of ligustrazine as a salvage agent in patients with relapsed orrefractory NHL,and the relationship to P-gp expression.Methods Sixty patients were randomized to a reversal agent group,receiving ligustrazine plus chemotherapy,and acontrol group,receiving chemotherapy alone.Flow cytometry was performed to evaluate P-gp expression.Results In the 56 patients we were able to evaluate,there was no statistically significant difference in progression-freesurvival （PFS） in the two groups （P=0.0651）,but the reversal agent group had a higher overall response rate （ORR） thandid the control group （P=0.048）.Forty-one of 56 patients had P-gp（+） tumor cells.Among these patients,six of eighteenpatients in the reversal agent group and in the control group had complete remission or complete remission/unconfirmed（CR+CRu） reflecting a significant advantage in the reversal agent group （P=0.048）.Patients with P-gp（+） tumor cells inthe reversal agent group had a higher overall response rate （ORR） than did the control group （11/18 vs.6/23,P=0.024）.Kaplan-Meier Survival curve and log-rank test demonstrated that patients with P-gp（+） tumor cells in the reversal agentgroup had longer progression-free survival than did the control group （P=0.0464）.A small number of patients whoreceived ligustrazine had a decrease in blood pressure.Conclusion Ligustrazine as a salvage agent in combination with chemotherapy can elevate response rate,prolongPFS with manageable toxicity,and correlate with P-gp expression in relapsed or refractory NHL.