摘要
目的 探讨面部中线鼻和鼻型自然杀伤 (NK/T)细胞淋巴瘤的治疗策略及有关临床特征。方法 回顾性比较分析 37例面部中线鼻和鼻部NK/T细胞非霍奇金淋巴瘤不同治疗组的近期疗效及 2年生存率和患者的临床特征。全部患者初治均接受CHOP联合化疗 2个疗程 ,治疗有效继续化疗 6个疗程 ,后给予病灶野放疗 ,其中 10例患者达到完全缓解 (普通组 )。CHOP联合化疗 2个疗程不能达到部分缓解或恶化的 2 7例患者 (难治组 ) ,其中 14例给予左旋门冬酰胺酶 (L ASP)为主的挽救联合化疗 (L ASP组 ) ,13例接受不含L ASP的挽救化疗 (非L ASP组 ) ,化疗后给予病灶野放疗。普通组患者临床特征表现无持续发热 ,无血管浸润性生长及灶性坏死病理组织学改变 ,国际预后指数计分 (IPI) 0～ 1,并多为Ⅰ、Ⅱ期 (70 % ) ;难治组 92 %患者表现高热、78%表现血管浸润性生长及灶性坏死、85 %为IPI≥ 2 ,及 82 %属Ⅲ、Ⅳ期。结果 治疗完全缓解率 46 % ;普通组 10 0 % ,难治组 2 6 % (P <0 .0 0 5 ) ;难治组中L ASP组 5 0 % ,非L ASP组无完全缓解患者 (P <0 0 5 )。全组 2年生存率 43% ;普通组 10 0 % ,难治组 2 0 % (P <0 .0 0 5 ) ;难治组中的L ASP组为 5 0 % ,非L ASP组无完全缓解患者 (P <0 0 0 5 )。大多数难治组患者表现发热。
Objective To study the clinical characteristics and treatment of midline nasal and nasal type T/Nk cell non Hodgkin lymphoma. Methods A retrospective study was made on the clinical characteristics, treatment, short term effect, and two year survival rate of 37 patients with midline nasal and nasal type T/NK non Hodgkin lymphoma. Results All of the patients were primarily treated with 2 cycles of CHOP chemotherapy. Ten of them were with good effect (common group). Then they were given 6 cycles of chemotherapy followed by focal radiotherapy and reached complete remission (CM). The other 27 patients failed to reach partial remission (PM) or even with their condition worsened after 2 cycles of CHOP regimen and were included into the refractory group. Fourteen of them received L asparaginase based salvage chemotherapy followed by focal radiotherapy (L ASP group), and salvage therapy without L ASP and followed by focal radiotherapy was given to the other 13 patients (non L ASP group). Continuous fever, angioinvasive growth and necrotic lesion could not be found among the patients in the common group. Their international prognostic indexes (IPI) were 0～1. Seventy percent of them were at the stages I or II. Continuous fever, angioinvasive growth and necrotic lesion could be found in the patients in refractory group. The IPIs among 85% of them were >2, and 82% of them were at the stages III and IV. The CR rate was 46% for all patients as a whole, 100% for the common group, 26% for the refractory group ( P <0 005); and was 50% for the L ASP group and 0% for the non L ASP group ( P <0 005). The 2 year survival rate was 43% for all patients as a whole, 100% for the common group, 20% for the refractory group ( P <0 005); and was 50.8% for the L ASP group and 0% for the non L ASP group ( P <0 005). Conclusion Patients with midline nasal and nasal type T/NK non Hodgkin lymphoma can be treated primarily by CHOP regimen and local radiotherapy. Refractory patients can be treated by salvage therapy based on L ASP chemotherapy with a rather good effect. The clinical characteristics of most of the refractory patients include continuous fever, angioinvasive growth, necrotic lesion, being at stage III and IV, and with an IPI >2.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2001年第13期773-775,共3页
National Medical Journal of China
