Key words】 gemcitabine shore; non-Hodgkin’s lymphoma; refractory; recurrence; efficacy; toxicity
Non-Hodgkin’s lymphoma (non Hodgkin lymphoma, NHL) is a heterogeneous group of strong or more elective lymphoid malignancies. Traditional anthracycline-based The CHOP chemotherapy regimens is the NHL’s classic treatment program, but only 50% to 60% of patients achieved complete remission (CR), half of the patients are still the primary drug resistance or ease the recurrence need remedial treatment . The the although there ESHAP, m BACOD proMACE / cytoBOM remedial treatment regimens in the treatment of refractory or recurrent NHL, the remission rate of only 20% to 30% . Therefore choose effective remedial treatment program is the urgent need to address the problem of the treatment of refractory or recurrent NHL. In recent years with gemcitabine chemotherapy in the treatment of NHL nonvolatile memories. Hematology of our hospital from January 2004 to March 2007 using gemcitabine combined with carboplatin and dexamethasone (GCD program) the treatment of refractory or recurrent NHL20 cases, observe the efficacy and toxicity, and obtain better results , are reported below.
1 Materials and Methods
1.1 General Information
20 patients by biopsy and immunohistochemical detection diagnosed NHL. 22 to 79 years of age, with a median age of 48 years old. 12 males and 8 females. All patients received CHOP chemotherapy. Refractory NHL7 cases, after two or more cycles of CHOP chemotherapy without remission; the the recurrent the NHL13 cases, after more than four courses of CHOP regimen relapse after chemotherapy remission, the median duration of remission 10 months. 20 patients with pathological classification (the lymphoid neoplasms WHO2001 standard) and IPI prognostic classification situation, see Table 1.
Gemcitabine 1 000 mg/m2, intravenous saline 100 ml and d1, 8; carboplatin 100 mg/m2, d1 the intravenous drip Table 1 GCD program clinical efficacy of CR for the treatment of refractory or recurrent NHL, complete remission ; PR, partial remissions; SD, stable disease; PD, progressive disease; Note; dexamethasone 20 mg/m2, d1 ~ 4, intravenous infusion. Chemotherapy 3 to 4 weeks repeat, all patients treatment at least 2 cycles. Liver and kidney function, electrolytes and ECG before and after chemotherapy review and timely symptomatic treatment.
1.2.2 evaluation standard and toxicity evaluation
All efficacy in patients with solid tumors, according to the WHO (1981) developed an objective evaluation standard evaluation of efficacy, sub-complete remission (CR), partial remission (PR), stable (SD), progress (PD), total efficiency of the CR + PR . Toxicity were evaluated according to the WHO anticancer drug toxicity (0 ~ Ⅳ) indexing standards.
1.2.3 Statistical Methods
SAS 6.12 software for statistical analysis. 20 cases of patients the Source divided into two groups according to T and B cells, according to IPI prognosis divided into three groups, the overall clinical efficacy analysis, statistical methods using the chi-square test method fourfold table and 2 × K table.
2.1 The effect of
20 patients with NHL, CR6 cases, accounting for 30.0%; the PR7 cases, accounting for 35.0%; total effective rate of 65.0%. 0.05（Fisher精确检验）,差异无统计学意义。">B-cell NHL, the total effective rate of 76.9%, and T-cell NHL, the total effective rate of 42.9%, the two groups, the total effective rate (P> 0.05) (Fisher’s exact test), the difference was not statistically significant. According to the IPI prognostic classification, three groups overall efficiency is not the same (P <0.05), low in the highest risk group, the lowest high-risk group, as shown in Table 1.
Bone marrow suppression, this article summarizes the cases of leukopenia, anemia and thrombocytopenia common. Nausea, vomiting than common Ⅰ ~ Ⅱ. Such as the liver, kidney, and cardiac toxicity incidence is low, as shown in Table 2. Table 2 GCD the treatment of refractory or recurrent NHL toxicity
In the past 20 years, the incidence of NHL worldwide was the trend continues to rise, traditional CHOP regimen failed or relapsed NHL clinical problem. Treatment options for refractory or recurrent NHL is no standard at home and abroad, it is looking for a new type of chemotherapy drugs and combination chemotherapy clinical urgent need to address the problem.
Gemcitabine as a a new generation of pyrimidine analogue cytarabine, which is mainly used for the treatment of non-small cell lung cancer and pancreatic cancer and other solid tumors. But in recent years, gemcitabine is often used in the NHL’s second-line treatment, Sampol A, Ng M [3,4] gemcitabine in combination with corticosteroids (methylprednisolone or dexamethasone) and platinum (cisplatin or Austrian oxaliplatin) in the treatment of refractory or recurrent NHL made a good effect, some scholars recently reported Gemcitabine, cisplatin and methylprednisolone re-Ghali rituximab treatment of relapsed or refractory DLBCL achieved good efficacy , it is worthy of further observation of gemcitabine in the treatment of NHL.
This article summarizes the 20 cases of the GCD program treatment of refractory or recurrent NHL, the results showed that the total effective rate of 65%, similar to and MaS, Ng M, reported [1,4]. The GCD program major toxicity to bone marrow suppression, anemia, neutropenia and thrombocytopenia are more common, only a small number of patients with severe bone marrow suppression, most patients after application of G CSF, transfusion of platelets and red blood cell suspension processing can recovery. The digestive toxicity as nausea, vomiting 65%, mainly Ⅰ ~ Ⅱ. The lower incidence of heart, lung, liver and other organ toxicity. All patients had no chemotherapy-related deaths.
As can be seen from the results of this paper, CR and PR is more common in B-cell origin of DLBCL, FL and MCL. Combined with local radiotherapy in patients with nasal-type NK / TCL available a good short-term effect, achieved PR1 T LBL, T-cell origin of PTCL ALCL used the GCD program only ALCL cases. In addition, the article summarizes cases can also see the the GCD program for high-risk group efficiency was significantly lower than the low-risk group in the high risk group.
In summary, GCD program as refractory or relapsed lymphoma remedial therapy is an effective treatment programs, and its toxicity is relatively small and well tolerated in patients. This paper summarizes the small number of cases, so the GCD in the treatment of refractory or recurrent NHL effect needs further observation in the expansion of the number of cases.