[改良版NHL-BFM-90方案应用于预后不良的原发性弥漫性大B细胞胃淋巴瘤成年患者的首次经验]

[First experience with the modified program NHL-BFM-90 application in adult patients with primary diffuse large B-cell gastric lymphosarcoma with unfavourable prognosis].

作者信息

Zvonkov E E, Krasil'nikova B B, Makhinia V A, Kaplanskaia I B, Kravchenko S K, Karagiulian S R, Grzhimolovskiĭ A V, Kuznetsov A N, Magomedova A U, Shukhman I M, Bariakh E A, Giliazitdinova E A, Gubkin A V, Lorie Iu Iu, Kremenetskaia A M, Vorob'ev A I

出版信息

Ter Arkh. 2006;78(7):38-46.

PMID:16944749

Abstract

AIM

To assess efficacy of a modified program NHL-BFM-90 in adult patients with primary diffuse large B-cell gastric lymphosarcoms (PDLBGL) with unfavourable prognosis.

MATERIAL AND METHODS

Modified courses of NHL-BFM-90 were conducted in 5 patients aged 27-67 years from January 2004 to September 2005. Four patients received chemotherapy of the first line, in one patient block therapy followed monotherapy with chlorambucil and a CHOEP course. All the patients were in a severe clinical condition and had several initial factors of unfavourable prognosis: size of the tumor more than 10 cm; stage IE and more advanced; B-symptoms; proliferative activity above 70%. The program NHL-BFM-90 was modified because of the patients' age. Chemotherapy was conducted according to the middle arm of the original program NHL-BFM-90, but methotrexate was introduced in a dose 1 g/m2 for 12 hours, while leukovorin was given 18 hours after the start of methotrexate injection. In two cases the blocks were enhanced with rituximab, 2 patients had doxorubicin in block A, in one case block C was enhanced with methotrexate. A total of 23 modified blocks NHL-BFM-90 were performed: one patient was given 6 blocks, two patients--5, one patient--4 blocks and one patient--3 blocks.

RESULTS

Four patients after block 2 and one patient after block 3 of polychemotherapy NHL-BFM-90 achieved remission of the disease of 6 to 22 months duration which still continues. Infectious complications related to hematological toxicity arose more frequently at the latest courses of chemotherapy.

CONCLUSION

Treatment according to the modified program NHL-BFM-90 in adult patients with PDLBGL and unfavourable prognosis is highly effective. For a mean follow-up of 10.2 months no recurrences occurred. The number of courses can be reduced to decrease accumulated hematological toxicity and in case of rapid achievement of remission.

摘要

目的

评估改良版NHL - BFM - 90方案对预后不良的原发性弥漫性大B细胞胃淋巴瘤（PDLBGL）成年患者的疗效。

材料与方法

2004年1月至2005年9月，对5例年龄在27 - 67岁的患者实施改良版NHL - BFM - 90疗程。4例患者接受一线化疗，1例患者先进行联合化疗，随后接受苯丁酸氮芥单药治疗及CHOEP疗程。所有患者临床病情严重，具有多个预后不良的初始因素：肿瘤大小超过10厘米；IE期及更晚期；B症状；增殖活性高于70%。因患者年龄对NHL - BFM - 90方案进行了改良。化疗按照原NHL - BFM - 90方案的中间方案进行，但甲氨蝶呤剂量为1 g/m²，持续12小时，亚叶酸钙在甲氨蝶呤注射开始后18小时给予。2例患者的联合化疗中使用利妥昔单抗加强，2例患者在A组使用阿霉素，1例患者在C组使用甲氨蝶呤加强。共进行了23个改良版NHL - BFM - 90联合化疗疗程：1例患者接受6个疗程，2例患者接受5个疗程，1例患者接受4个疗程，1例患者接受3个疗程。