Wöhrer S, Chott A, Drach J, Püspök A, Hejna M, Hoffmann M, Raderer M
Department of Internal Medicine I, Division of Oncology, University of Vienna, Vienna, Austria.
Ann Oncol. 2004 Nov;15(11):1680-3. doi: 10.1093/annonc/mdh427.
Enteropathy-type intestinal T-cell lymphoma (ETCL) is a highly aggressive disease with poor response to conventional CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy. According to promising data with the addition of etoposide (E) to the CHOP regimen (CHOEP) in aggressive lymphomas including T-cell lymphomas, we have treated patients with ETCL with CHOEP chemotherapy.
Ten consecutive patients (six female, four male) suffering from ETCL were given CHOEP at our institution. Four patients had advanced disease (stage III/IV), while five patients were rated to be in stage II and one in stage I. Treatment consisted of doxorubicin 50 mg/m2, cyclophosphamide 750 mg/m2 and vincristine 1.4 mg/m2 by intravenous infusion on day 1, etoposide 100 mg/m2 intravenously days 1-3 and oral prednisone days 1-5. Cycles were repeated every 3 weeks for a maximum of six courses. Assessment of response was done by means of conventional computed tomography scanning, endoscopy and also [18F]fluorodeoxyglucose positron emission tomography (FDG PET) in seven patients.
A total of 41 cycles (median six, range one to six) were administered to our patients. Leukocytopenia/neutropenia WHO grade IV necessitating granulocyte colony-stimulating factor support occurred in all patients evaluable for toxicity, and febrile neutropenia was seen in two patients. Two patients had to undergo emergency surgery due to intestinal perforation after one and three courses of treatment, respectively. Therapeutic results, however, were disappointing: two patients had complete remission (CR), three had partial remissions and five patients progressed during treatment. Remissions, however, where only short-lasting, as only two patients are alive at a median follow-up of 7 months (range 2-16). One patient is in ongoing CR 10 months after initiation of chemotherapy and the other is currently undergoing second-line treatment for progressive disease as judged by follow-up investigations after three cycles of CHOEP.
Our data demonstrate that CHOEP chemotherapy results in a high rate of hematotoxicity in patients with ETCL. In spite of this, therapeutic results were disappointing and do not appear to be superior to conventional CHOP chemotherapy. We conclude that CHOEP cannot be recommended for routine use in patients with ETCL.
肠病型肠道T细胞淋巴瘤（ETCL）是一种侵袭性很强的疾病，对传统的CHOP（环磷酰胺、阿霉素、长春新碱和泼尼松）化疗反应不佳。鉴于在包括T细胞淋巴瘤在内的侵袭性淋巴瘤中，在CHOP方案（CHOEP）中加入依托泊苷（E）取得了有前景的数据，我们采用CHOEP化疗治疗ETCL患者。
我们机构连续收治了10例ETCL患者（6例女性，4例男性），给予CHOEP治疗。4例患者为晚期疾病（III/IV期），5例患者为II期，1例为I期。治疗方案为第1天静脉输注阿霉素50mg/m²、环磷酰胺750mg/m²和长春新碱1.4mg/m²，第1 - 3天静脉输注依托泊苷100mg/m²，第1 - 5天口服泼尼松。每3周重复1个周期，最多进行6个疗程。7例患者通过传统计算机断层扫描、内镜检查以及[18F]氟脱氧葡萄糖正电子发射断层扫描（FDG PET）评估疗效。
我们的患者共接受了41个周期（中位周期数为6个，范围1 - 6个）的治疗。所有可评估毒性的患者均出现了需要粒细胞集落刺激因子支持的WHO IV级白细胞减少/中性粒细胞减少，2例患者出现发热性中性粒细胞减少。2例患者分别在接受1个和3个疗程治疗后因肠穿孔接受了急诊手术。然而，治疗结果令人失望：2例患者完全缓解（CR），3例部分缓解，5例患者在治疗期间病情进展。然而，缓解期很短，中位随访7个月（范围2 - 16个月）时只有2例患者存活。1例患者在化疗开始10个月后持续完全缓解，另1例患者根据CHOEP三个周期后的随访调查判断，目前正在接受针对进展性疾病的二线治疗。
我们的数据表明，CHOEP化疗在ETCL患者中导致血液毒性发生率很高。尽管如此，治疗结果令人失望，似乎并不优于传统的CHOP化疗。我们得出结论，不推荐CHOEP用于ETCL患者的常规治疗。
