培门冬酶联合CHOP治疗弥漫大B细胞淋巴瘤的临床观察
|
摘要
目的探讨培门冬酶(pegasparaginase,PEG-Asp)联合CHOP方案治疗弥漫大B细胞淋巴瘤的疗效及对免疫功能的影响。方法选取2014年6月至2017年12月我院住院治疗的120例晚期弥漫大B细胞淋巴瘤患者,随机分为观察组及对照组,各60例,对照组给予CHOP方案化疗,观察组在对照组治疗的基础上加用培门冬酶,比较两组临床疗效、不良反应及免疫功能。结果观察组临床有效率(53/60,88.3%)高于对照组(41/60,68. 3%),差异具有统计学意义;两组治疗后CD3~+T、CD4~+T细胞百分比、CD4~+T/CD8~+T比值比较,差异均有统计学意义;两组的主要不良反应为骨髓抑制和胃肠道反应,不良反应发生率差异无统计学意义。结论培门冬酶辅助治疗弥漫大B细胞淋巴瘤临床疗效显著,不增加化疗毒性,减轻化疗药物对免疫功能的抑制,值得临床进一步推广。
Objective To investigate the clinical effect of pegasparaginase combined with CHOP on immune function in the treatment of diffuse large B cell lymphoma. Methods 120 patients with advanced diffuse large B-cell lymphoma hospitalized in our hospital from June 2014 to December 2017 were randomly divided into the observation group and the control group,with 60 cases in each group. The control group was given CHOP regimen chemotherapy,while the observation group was also given the perninasinasse. The clinical effects,adverse reactions and immune function were observed in both groups. Results The clinical effective rate of the observation group(53/60,88. 3%) was higher than that of the control group(41/60,68. 3%). There were significant differences in the percentage of CD4~+ T/CD8~+ T and the ratio of CD4~+ T/CD8~+ T between the two groups after the treatment. The main adverse reactions of the two groups were myelosuppression and gastrointestinal tract reaction. There were no differences in adverse reactions rate between the two groups.Conclusion The clinical efficacy of asparaginase in the treatment of diffuse large B-cell lymphoma is remarkable,with non-increase of the toxicity of chemotherapy, and the alleviation of inhibition of immune function by chemotherapeutic drugs,which is worthy of further clinical promotion.
Objective To investigate the clinical effect of pegasparaginase combined with CHOP on immune function in the treatment of diffuse large B cell lymphoma. Methods 120 patients with advanced diffuse large B-cell lymphoma hospitalized in our hospital from June 2014 to December 2017 were randomly divided into the observation group and the control group,with 60 cases in each group. The control group was given CHOP regimen chemotherapy,while the observation group was also given the perninasinasse. The clinical effects,adverse reactions and immune function were observed in both groups. Results The clinical effective rate of the observation group(53/60,88. 3%) was higher than that of the control group(41/60,68. 3%). There were significant differences in the percentage of CD4~+ T/CD8~+ T and the ratio of CD4~+ T/CD8~+ T between the two groups after the treatment. The main adverse reactions of the two groups were myelosuppression and gastrointestinal tract reaction. There were no differences in adverse reactions rate between the two groups.Conclusion The clinical efficacy of asparaginase in the treatment of diffuse large B-cell lymphoma is remarkable,with non-increase of the toxicity of chemotherapy, and the alleviation of inhibition of immune function by chemotherapeutic drugs,which is worthy of further clinical promotion.
引文
[1] WITZIQ T E,MAURER M J,HABERMANN T M,et al. Elevated monoclonal and polyclonal serum immunoglobulin free light chain as prognostic factors in B-and T-cell non-Hodgkin lymphoma[J]. Am J Hematol,2014,89(12):1116-1120.
[2]易成华,李康保.沙利度胺联合CHOP方案治疗弥漫大B细胞淋巴瘤临床研究[J].河南医学研究,2016,25(1):96-97.
[3]李志慧,邢朋涛,张彦平,等.含PLD的CHOP方案用于高龄晚期DLBCL一线化疗的疗效及安全性[J].中国实验血液学杂志,2016,24(3):744-748.
[4]平凌燕,郑文,王小沛,等.培门冬酶联合化疗治疗淋巴瘤的安全性分析[J].中华医学杂志,2012,92(46):3257-3260.
[5]曹欣欣,李剑,张薇,等.培门冬酶联合化疗治疗急性淋巴细胞白血病与T细胞非霍奇金淋巴瘤的安全性分析[J].中华血液学杂志,2015,36(3):177-180.
[6]孙燕.内科肿瘤学[M].北京;人民卫生出版社,2001:90.
[7] BORAD M J,BABIKER H M, ANTHONY S,et al. A multicenter,open-label, Phase 1 study evaluating the safety and tolerability of pegaspargase in combination with gemcitabine in advanced metastatic solid tumors and lymphoma[J]. Cancer Invest,2015,33(5):172-179.
[8]贾垂明,白力允,孔令珍,等.多柔比星脂质体治疗老年B细胞淋巴瘤疗效观察[J].哈尔滨医科大学学报,2017,51(4):345-347.
[9]彭志强,董涵之,双跃荣.含培门冬酶的化疗方案治疗淋巴瘤的安全性分析[J].江西医药,2016,51(06):507-509.
[10]李丹妮,丁雯雯,魏平平.培门冬酶对急性淋巴细胞白血病儿童凝血功能的影响[J].药物不良反应杂志,2017, 19(3):174-177.
[11] WEN J Y,LI M,LI X,et al. Efficacy and tolerance of pegaspargasebased chemotherapy in patients with nasal-type extranodal NK/Tcell lymphoma:a pilot study[J]. Asian Pac J Cancer Prev,2014,15(15):6275-6281.
[12]彭娟,王丽娜,易容松.培门冬酶治疗儿童初发急性淋巴白血病的近期疗效[J].广西医学,2017,39(9):1416-1418.
[13]胡聪玲.分析培门冬酶联合化疗治疗淋巴瘤的效果观察[J].中国保健营养,2014,24(3):1570-1571.
[14]朱丽,郑彤,刘琳,等.培门冬酶联合化疗治疗淋巴瘤的安全性分析[J].医药前沿,2017,7(4):210-211.
[15]曹欣欣,李剑,张薇,等.培门冬酶联合化疗治疗急性淋巴细胞白血病与T细胞非霍奇金淋巴瘤的安全性分析[J].中华血液学杂志,2015,36(3):177-180.
[16]马军,秦叔逵,沈志祥,等.培门冬酶治疗急性淋巴细胞白血病和恶性淋巴瘤的专家共识[J].临床肿瘤学杂志,2013,18(3):256-263.
[17]徐燕,王瑾,杨楠,等.基于培门冬酶的化疗用于治疗急性淋巴细胞白血病和T细胞淋巴瘤的临床疗效和安全性比较研究[J].中国实验血液学杂志,2016,24(2):405-410.
[18]任羽,贺爱军.培门冬酶辅助治疗血管免疫母细胞T淋巴瘤的临床观察[J].川北医学院学报,2017,32(3):429-432.
[19]张克,于晓丽,韩春山.培门冬酶和左旋门冬酰胺酶治疗NK/T细胞淋巴瘤的疗效和安全性[J].国际肿瘤学杂志,2017,44(2):104-107.
[20] KOVACS S B,SHEIKH V,THOMPSON W L,et al. T-cell depletion in the colonic mucosaof patients with idiopathic CD4~+lymphopenia[J].J Infect Dis,2015,212(10):1579-1587.
[21] PENTHEROUDAKIS G,RAPTOU G,KOTOULA V,et al. Immune response gene expression in colorectal cancer carries distinct prognostic implications according to tissuet stage and site:a prospective retrospective translational study in the context of a Hellenic cooperative oncology group randomised trial[J]. PLoS One,2015,10(5):e0124612.
[2]易成华,李康保.沙利度胺联合CHOP方案治疗弥漫大B细胞淋巴瘤临床研究[J].河南医学研究,2016,25(1):96-97.
[3]李志慧,邢朋涛,张彦平,等.含PLD的CHOP方案用于高龄晚期DLBCL一线化疗的疗效及安全性[J].中国实验血液学杂志,2016,24(3):744-748.
[4]平凌燕,郑文,王小沛,等.培门冬酶联合化疗治疗淋巴瘤的安全性分析[J].中华医学杂志,2012,92(46):3257-3260.
[5]曹欣欣,李剑,张薇,等.培门冬酶联合化疗治疗急性淋巴细胞白血病与T细胞非霍奇金淋巴瘤的安全性分析[J].中华血液学杂志,2015,36(3):177-180.
[6]孙燕.内科肿瘤学[M].北京;人民卫生出版社,2001:90.
[7] BORAD M J,BABIKER H M, ANTHONY S,et al. A multicenter,open-label, Phase 1 study evaluating the safety and tolerability of pegaspargase in combination with gemcitabine in advanced metastatic solid tumors and lymphoma[J]. Cancer Invest,2015,33(5):172-179.
[8]贾垂明,白力允,孔令珍,等.多柔比星脂质体治疗老年B细胞淋巴瘤疗效观察[J].哈尔滨医科大学学报,2017,51(4):345-347.
[9]彭志强,董涵之,双跃荣.含培门冬酶的化疗方案治疗淋巴瘤的安全性分析[J].江西医药,2016,51(06):507-509.
[10]李丹妮,丁雯雯,魏平平.培门冬酶对急性淋巴细胞白血病儿童凝血功能的影响[J].药物不良反应杂志,2017, 19(3):174-177.
[11] WEN J Y,LI M,LI X,et al. Efficacy and tolerance of pegaspargasebased chemotherapy in patients with nasal-type extranodal NK/Tcell lymphoma:a pilot study[J]. Asian Pac J Cancer Prev,2014,15(15):6275-6281.
[12]彭娟,王丽娜,易容松.培门冬酶治疗儿童初发急性淋巴白血病的近期疗效[J].广西医学,2017,39(9):1416-1418.
[13]胡聪玲.分析培门冬酶联合化疗治疗淋巴瘤的效果观察[J].中国保健营养,2014,24(3):1570-1571.
[14]朱丽,郑彤,刘琳,等.培门冬酶联合化疗治疗淋巴瘤的安全性分析[J].医药前沿,2017,7(4):210-211.
[15]曹欣欣,李剑,张薇,等.培门冬酶联合化疗治疗急性淋巴细胞白血病与T细胞非霍奇金淋巴瘤的安全性分析[J].中华血液学杂志,2015,36(3):177-180.
[16]马军,秦叔逵,沈志祥,等.培门冬酶治疗急性淋巴细胞白血病和恶性淋巴瘤的专家共识[J].临床肿瘤学杂志,2013,18(3):256-263.
[17]徐燕,王瑾,杨楠,等.基于培门冬酶的化疗用于治疗急性淋巴细胞白血病和T细胞淋巴瘤的临床疗效和安全性比较研究[J].中国实验血液学杂志,2016,24(2):405-410.
[18]任羽,贺爱军.培门冬酶辅助治疗血管免疫母细胞T淋巴瘤的临床观察[J].川北医学院学报,2017,32(3):429-432.
[19]张克,于晓丽,韩春山.培门冬酶和左旋门冬酰胺酶治疗NK/T细胞淋巴瘤的疗效和安全性[J].国际肿瘤学杂志,2017,44(2):104-107.
[20] KOVACS S B,SHEIKH V,THOMPSON W L,et al. T-cell depletion in the colonic mucosaof patients with idiopathic CD4~+lymphopenia[J].J Infect Dis,2015,212(10):1579-1587.
[21] PENTHEROUDAKIS G,RAPTOU G,KOTOULA V,et al. Immune response gene expression in colorectal cancer carries distinct prognostic implications according to tissuet stage and site:a prospective retrospective translational study in the context of a Hellenic cooperative oncology group randomised trial[J]. PLoS One,2015,10(5):e0124612.