目的 探讨3种不同化疗方案交替治疗老年(55～65岁)患者外周T细胞性淋巴瘤(PTCL)疗效和不良反应,评估其耐受性.方法 PTCL患者,其中外周T细胞淋巴瘤,无特殊型(PTCL-u)28例,间变大细胞型(ALCL)7例,血管免疫母细胞型(AIL)2例;Ⅰ～Ⅱ期9例,Ⅲ～Ⅳ期28例.IPI预后指数分析:低+中低危组10例,中高+高危组27例.初治患者25例,复发患者12例.给予阿霉素、顺铂、阿糖胞苷、甲泼尼龙(ASHAP方案),甲胺喋呤、亚叶酸钙、阿霉素、长春新碱、博来霉素、环磷酰胺、甲基泼尼松龙(m-BACOS方案)和美司钠、异环磷酰胺、米托蒽醌、足叶乙甙(MINE方案)3种方案交替化疗,预期完成3次循环,共9疗程,随访28个月,观察疗效及不良反应.结果 完成4疗程4例(10.8%),完成6疗程30例(81.1%),完成9疗程19例(55.4%),获得完全缓解25例(67.6%),部分缓解6例(16.2%),无效6例(16.2%),总有效率83.8%.24个月总生存率56.8%(21/37),2年无疾病进展生存率54.1%(20/37).最为常见的非血液学不良反应为恶心、呕吐、便秘和脱发,其次为肝脏毒性、发热、黏膜炎和感染.Ⅰ～Ⅱ度骨髓抑制25例,Ⅲ～Ⅳ9例,34完成≥4疗程的患者均需使用重组人粒细胞集落刺激因子(G-CSF),共有28例,约75.7%患者因不良反应而需减剂量,没有发生治疗相关死亡病例.结论 ATT方案对老年PTCL患者具有较好的疗效和耐受性,可以作为PTCL治疗的选择方案.%Objective To evaluate the results and side effects of alternating triple therapy(ATT) regimen in 5565 age group peripheral T cell lymphoma patients.Methods A total of 37 patients were enrolled into study,including peripheral T cell lymphoma unspecific (PTCL-u) ( n = 28), anaplastic large cell lymphoma (ALCL) ( n = 7) and angioimmunoblastic lymphoma(AIL)( n = 2).There were 9 patients in stage Ⅰ- Ⅱ and 28 patients in stage Ⅲ-Ⅳ.According to International Prognostic Index(IPI), 10 patients were classified low/low intermediate, 27 high/high intermediate.These patients received doxorubicin cisplatin ara-C solu medrol (ASHAP), methotrexate leucovorin doxorubicin oncovin bleomycin cytoxan, solu medrol(m-BACOS) and mesna ifosfamide novantrone etoposide(MINE)alternatively,aiming at 3 cycles,9 courses and follow-up for 28 months.Curative effect and side effect were observed.Results There were 4 cases( 10.8 ％ ),30 cases(81.1 ％ ) and 19 cases(55.4 ％ ) who had respectively finished 4,6 and 9 courses.25 cases(67.6 ％ ) achieved complete response, 6 cases( 16.2 ％ ) partial response and 6 cases( 16.2 ％ ) failed the therapy.After follow-up for 24 months, actuarial overall survival and progression-free survival were 56.8 ％ (21/37) and 54.1％(20/37).The main nonhematologic toxities were nausea, vomiting, constipation and alopecia followed by liver toxicity,fever, mucositis and infection.Twenty-five patients were classified grade Ⅰ- Ⅱ myelo-suppression, 9 cases grade Ⅲ-Ⅳ and 34 cases after four courses of treatment were supported by G-CSF.No treatment-related death occurred,but 28 cases(75.7 ％ ) needed dose adjustments according to the protocol.Conclusion ATT regimen might be beneficial for PTCL and safely applied in older patients.
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