Radford J A, Whelan J S, Rohatiner A Z, Deakin D, Harris M, Stansfeld A G, Swindell R, Wilkinson P M, James R D, Lister T A
CRC Department of Medical Oncology, Christie Hospital, Manchester, U.K.
Ann Oncol. 1994 Feb;5(2):147-51. doi: 10.1093/oxfordjournals.annonc.a058767.
BACKGROUND AND PATIENTS: A weekly schedule of chemotherapy (VAPEC-B) has been used to treat 184 consecutive patients with high grade non-Hodgkin's lymphoma (NHL). Median age for the group was 57 years (range 17-84) and 56% had stage IV disease.
Following chemotherapy, 114 (62%) patients achieved CR or CR(u), 32 (17%) PR and 15 (8%) had not responded or progressed. Response to VAPEC-B was highly stage dependent with 70% or more of patients with stages I-III achieving CR or CR(u) but only 50% of those with stage IV. Twenty-four (15%) patients died during treatment with VAPEC-B and in 13 cases death was due to sepsis. This complication occurred mainly in patients with stage IV disease aged 60 years or older. After a median follow up period of 4.1 years, the actuarial 4 year survival for 184 patients is 45%, an overall result heavily influenced by the poor outcome for 103 patients with stage IV disease (4 year survival of 28%). Patients with earlier stage disease fared correspondingly better (44% for stage III, 68% for stage II and 80% for stage I).
VAPEC-B gives similar results to other chemotherapy regimens currently used in the treatment of high grade NHL and has the advantage of brevity. Caution is advised in patients over the age of 60 especially in the presence of stage IV disease and dose reduction or haemopoietic growth factor support should be considered in these circumstances.
背景与患者：采用每周一次的化疗方案（VAPEC - B）连续治疗了184例高级别非霍奇金淋巴瘤（NHL）患者。该组患者的中位年龄为57岁（范围17 - 84岁），56%的患者为IV期疾病。
化疗后，114例（62%）患者达到完全缓解（CR）或未确认的完全缓解（CR(u)），32例（17%）部分缓解（PR），15例（8%）无反应或病情进展。VAPEC - B方案的疗效高度依赖分期，I - III期患者中70%或更多达到CR或CR(u)，而IV期患者中只有50%。24例（15%）患者在接受VAPEC - B治疗期间死亡，其中13例死于败血症。这种并发症主要发生在60岁及以上的IV期疾病患者中。中位随访期4.1年后，184例患者的4年精算生存率为45%，这一总体结果受到103例IV期疾病患者不良预后的严重影响（4年生存率为28%）。早期疾病患者的情况相应较好（III期为44%，II期为68%，I期为80%）。
VAPEC - B方案与目前用于治疗高级别NHL的其他化疗方案效果相似，且具有疗程短的优点。建议60岁以上患者谨慎使用，尤其是存在IV期疾病的患者，在这种情况下应考虑减少剂量或给予造血生长因子支持。
