改良SMILE方案治疗结外NK/T细胞淋巴瘤初探

摘要

Objective:To discuss the short-term efficacy and adverse effects of modified SMILE regimen in the treatment of nasal type extranodal NK/T-cell lymphoma. Methods:From June 2009 to March 2012,7 patients with stage Ⅲ and stageⅣENKTL-NT were involved in this study. Among them,4 patients were refractory and 3 patients were newly diagnosed. All patients were treated with modified SMILE protocol(Methylprednisolone 80mg,iv,d2-5;If-osfamide(IFO)1.333g/m2,iv,d2-5,the United States department of sodium(Mesna)300mg/m2,iv,drug 0,4 and 8h,etoposide(Vp-16)75mg/m2,iv,d2-5;Culture door winter enzyme(Pegasparaginase)2500IU/m2,im,d1;Meth-otrexate(MTX)1. 0g/m2,iv,6h). Results:All 7 patients received a total of SMILE regimen for 31 cycles. each case at least two cycles,Among the 7 patients,5 patients achieved complete remission,1 patient achieved partial remission and 1 patient was progressing. The overall response was 85. 7%,complete response rate was 71. 4%. Among them, grade Ⅲ-Ⅳ leucopenia was observed in 11 cycles,grade Ⅲ-Ⅳ hemoglobin decreased was observed in 3 cycles, gradeⅢ-Ⅳ thrombocytopenia was observed in 6 cycles,grade Ⅲ liver dysfunction was observed in 4 cycles. Con-clusion:Modified SMILE regimen is an effective treatment regimen for newly diagnosed,refractory patients with ENK-TL-NT.%目的：观察改良SMILE方案治疗结外NK/T细胞淋巴瘤的近期疗效和安全性。方法：2009年6月至2012年3月收治的7例Ⅲ-Ⅳ期患者，3例为初治，4例为复发、难治性患者，均采用改良SMLIE（甲基强的松龙80mg，iv，d2-5；异环磷酰胺（ IFO）1.333g/m2，iv，d2-5，美司钠（ Mesna）300mg/m2，iv，给药0、4、8h，依托泊苷（Vp-16）75mg/m2，iv，d2-5；培门冬酶（Pegasparaginase）2500IU/m2，im，d1；甲氨蝶呤（MTX）1.0g/m2，iv，6h， d5）方案化疗。结果：7例患者共接受SMILE方案化疗31周期，每例至少2个周期，其中，CR 5例，PR 1例，PD 1例，近期总有效率为85.7％，CR率为71.4％。其中，11周期出现Ⅲ﹢Ⅳ度白细胞减少，3周期出现Ⅲ﹢Ⅳ度血红蛋白下降，6周期出现Ⅲ﹢Ⅳ度血小板减少，4周期出现Ⅲ度肝功能损害，对症处理后恢复。结论：改良SMILE方案治疗初治或难治性NK/T细胞淋巴瘤疗效较好，毒性可以耐受，值得临床进一步探讨。